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Rothenberger A, Heinrich H. Co-Occurrence of Tic Disorders and Attention-Deficit/Hyperactivity Disorder-Does It Reflect a Common Neurobiological Background? Biomedicines 2022; 10:biomedicines10112950. [PMID: 36428518 PMCID: PMC9687745 DOI: 10.3390/biomedicines10112950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/06/2022] [Accepted: 11/09/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The co-existence of tic disorders and attention-deficit/hyperactivity disorder (TD + ADHD) has proven to be highly important in daily clinical practice. The factor ADHD is not only associated with further comorbidities, but also has a long-term negative psychosocial effect, while the factor TD is usually less disturbing for the major part of the patients. It remains unclear how far this is related to a different neurobiological background of the associated disorders or whether TD + ADHD reflects a common one. OBJECTIVE This review provides an update on the neurobiological background of TD + ADHD in order to better understand and treat this clinical problem, while clarifying whether an additive model of TD + ADHD holds true and should be used as a basis for further clinical recommendations. METHOD A comprehensive research of the literature was conducted and analyzed, including existing clinical guidelines for both TD and ADHD. Besides genetical and environmental risk factors, brain structure and functions, neurophysiological processes and neurotransmitter systems were reviewed. RESULTS Only a limited number of empirical studies on the neurobiological background of TD and ADHD have taken the peculiarity of co-existing TD + ADHD into consideration, and even less studies have used a 2 × 2 factorial design in order to disentangle the impact/effects of the factors of TD versus those of ADHD. Nevertheless, the assumption that TD + ADHD can best be seen as an additive model at all levels of investigation was strengthened, although some overlap of more general, disorder non-specific aspects seem to exist. CONCLUSION Beyond stress-related transdiagnostic aspects, separate specific disturbances in certain neuronal circuits may lead to disorder-related symptoms inducing TD + ADHD in an additive way. Hence, within a classificatory categorical framework, the dimensional aspects of multilevel diagnostic-profiling seem to be a helpful precondition for personalized decisions on counselling and disorder-specific treatment in TD + ADHD.
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Affiliation(s)
- Aribert Rothenberger
- Clinic for Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Göttingen, 37075 Göttingen, Germany
- Correspondence:
| | - Hartmut Heinrich
- Neurocare Group, 80331 Munich, Germany
- Kbo-Heckscher-Klinikum, 81539 Munich, Germany
- Research Institute Brainclinics, Brainclinics Foundation, 6524 AD Nijmegen, The Netherlands
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2
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Morand-Beaulieu S, Smith SD, Ibrahim K, Wu J, Leckman JF, Crowley MJ, Sukhodolsky DG. Electrophysiological signatures of inhibitory control in children with Tourette syndrome and attention-deficit/hyperactivity disorder. Cortex 2022; 147:157-168. [PMID: 35042055 PMCID: PMC8816877 DOI: 10.1016/j.cortex.2021.12.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 10/29/2021] [Accepted: 12/01/2021] [Indexed: 02/03/2023]
Abstract
Tourette syndrome (TS) and attention-deficit/hyperactivity disorder (ADHD) frequently co-occur, especially in children. Reduced inhibitory control abilities have been suggested as a shared phenotype across both conditions but its neural underpinnings remain unclear. Here, we tested the behavioral and electrophysiological correlates of inhibitory control in children with TS, ADHD, TS+ADHD, and typically developing controls (TDC). One hundred and thirty-eight children, aged 7-14 years, performed a Go/NoGo task during dense-array EEG recording. The sample included four groups: children with TS only (n = 47), TS+ADHD (n = 32), ADHD only (n = 22), and matched TDC (n = 35). Brain activity was assessed with the means of frontal midline theta oscillations, as well as the N200 and P300 components of the event-related potentials. Our analyses revealed that both groups with TS did not differ from other groups in terms of behavioral performance, frontal midline theta oscillations, and event-related potentials. Children with ADHD-only had worse Go/NoGo task performance, decreased NoGo frontal midline theta power, and delayed N200 and P300 latencies, compared to typically developing controls. In the current study, we found that children with TS or TS+ADHD do not show differences in EEG during a Go/NoGo task compared to typically developing children. Our findings however suggest that children with ADHD-only have a distinct electrophysiological profile during the Go/NoGo task as indexed by reduced frontal midline theta power and delayed N200 and P300 latencies.
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Affiliation(s)
| | - Stephanie D. Smith
- Child Study Center, Yale University School of Medicine, New Haven, CT, USA,School of Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
| | - Karim Ibrahim
- Child Study Center, Yale University School of Medicine, New Haven, CT, USA
| | - Jia Wu
- Child Study Center, Yale University School of Medicine, New Haven, CT, USA
| | - James F. Leckman
- Child Study Center, Yale University School of Medicine, New Haven, CT, USA
| | - Michael J. Crowley
- Child Study Center, Yale University School of Medicine, New Haven, CT, USA
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3
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Rachamim L, Mualem-Taylor H, Rachamim O, Rotstein M, Zimmerman-Brenner S. Acute and Long-Term Effects of an Internet-Based, Self-Help Comprehensive Behavioral Intervention for Children and Teens with Tic Disorders with Comorbid Attention Deficit Hyperactivity Disorder, or Obsessive Compulsive Disorder: A Reanalysis of Data from a Randomized Controlled Trial. J Clin Med 2021; 11:jcm11010045. [PMID: 35011787 PMCID: PMC8745193 DOI: 10.3390/jcm11010045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 12/06/2021] [Accepted: 12/21/2021] [Indexed: 11/16/2022] Open
Abstract
Attention deficit hyperactivity disorder (ADHD), obsessive compulsive disorder (OCD) and tic disorders (TD) commonly co-occur. In addition, specific inattention difficulties and poor impulse control are related to TD in the absence of comorbid ADHD. In this study we reanalyzed data from a recently completed study comparing internet-delivered, self-help comprehensive behavioral intervention for tics (ICBIT) with a waiting-list control group. The current study describes the effects of an (ICBIT) in children and adolescents with TD with and without comorbid diagnoses of ADHD or OCD at post intervention and over three- and six-month follow-up periods. Thirty-eight 7 to 18-year-olds completed the ICBIT. Of these, 16 were diagnosed with comorbid ADHD and 11 were diagnosed with OCD. A significant improvement in tic measures was found in all groups. Both the TD + ADHD and the TD − ADHD groups were similar in the magnitude of tic reduction from baseline to post-treatment, and at the three and six-month follow-up assessments. However, the TD + OCD group benefitted less from intervention than the TD—OCD group. There were meaningful reductions in parental reports of inattention, as well as hyperactive and impulsive symptoms at post intervention and over the 6-month follow-up period. Thus, ICBIT can be effectively delivered in the presence of comorbid ADHD or OCD symptomatology and may reduce symptoms of inattention and impulsivity. Larger studies of ICBIT in children and teens with TD and comorbid ADHD and OCD are needed to optimize responses to ICBIT.
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Affiliation(s)
- Lilach Rachamim
- School of Psychology, Reichman University IDC Herzliya, Herzliya 4610101, Israel; (H.M.-T.); (S.Z.-B.)
- Donald J. Cohen & Irving B. Harris Resilience Center, Association for Children at Risk, Tel Aviv 6719958, Israel
- Correspondence: ; Tel.: +972-528374405
| | - Hila Mualem-Taylor
- School of Psychology, Reichman University IDC Herzliya, Herzliya 4610101, Israel; (H.M.-T.); (S.Z.-B.)
| | - Osnat Rachamim
- Pediatric Movement Disorders Clinic, Pediatric Neurology Unit, Dana-Dwek Children’s Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel; (O.R.); (M.R.)
| | - Michael Rotstein
- Pediatric Movement Disorders Clinic, Pediatric Neurology Unit, Dana-Dwek Children’s Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel; (O.R.); (M.R.)
| | - Sharon Zimmerman-Brenner
- School of Psychology, Reichman University IDC Herzliya, Herzliya 4610101, Israel; (H.M.-T.); (S.Z.-B.)
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4
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Lee I, Lee J, Lim MH, Kim KM. Comparison of Quantitative Electroencephalography between Tic Disorder and Attention-Deficit/Hyperactivity Disorder in Children. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2021; 19:739-750. [PMID: 34690129 PMCID: PMC8553536 DOI: 10.9758/cpn.2021.19.4.739] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/22/2021] [Accepted: 07/23/2021] [Indexed: 12/31/2022]
Abstract
Objective Attention-deficit/hyperactivity disorder (ADHD) and tic disorder (TD) are among the most common comorbid psychopathologies and have a shared genetic basis. The psychopathological and neurophysiological aspects of the mechanism underlying the comorbidity of both disorders have been investigated, but the pathophysiological aspects remain unclear. Therefore, this study aimed to compare the neurophysiological characteristics of ADHD with those of TD using resting-state electroencephalography and exact low-resolution brain electromagnetic tomography (eLORETA) analysis. Methods We performed eLORETA analysis based on the resting-state scalp-recorded electrical potential distribution in 34 children with ADHD and 21 age-matched children with TD. Between-group differences in electroencephalography (EEG) current source density in delta, theta, alpha, beta, and gamma bands were investigated in each cortical region. Results Compared with the TD group, the ADHD group showed significantly increased theta activity in the frontal region (superior frontal gyrus, t = 3.37, p < 0.05; medial frontal gyrus, t = 3.35, p < 0.05). In contrast, children with TD showed decreased posterior alpha activity than those with ADHD (precuneus, t = −3.40, p < 0.05; posterior cingulate gyrus, t = −3.38, p < 0.05). These findings were only significant when the eyes were closed. Conclusion Increased theta activity in the frontal region is a neurophysiological marker that can distinguish ADHD from TD. Also, reduced posterior alpha activity might represent aberrant inhibitory control. Further research needs to confirm these characteristics by simultaneously measuring EEG-functional magnetic resonance imaging.
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Affiliation(s)
- Ilju Lee
- Department of Psychology, College of Health Science, Dankook University, Cheonan, Korea
| | - Jiryun Lee
- Department of Psychiatry, Dankook University Hospital, Cheonan, Korea
| | - Myung Ho Lim
- Department of Psychology, College of Health Science, Dankook University, Cheonan, Korea
| | - Kyoung Min Kim
- Department of Psychiatry, Dankook University Hospital, Cheonan, Korea.,Department of Psychiatry, College of Medicine, Dankook University, Cheonan, Korea
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Rothenberger A, Heinrich H. Electrophysiology Echoes Brain Dynamics in Children and Adolescents With Tourette Syndrome-A Developmental Perspective. Front Neurol 2021; 12:587097. [PMID: 33658971 PMCID: PMC7917116 DOI: 10.3389/fneur.2021.587097] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 01/19/2021] [Indexed: 11/28/2022] Open
Abstract
The development of the complex clinical picture of motor and vocal tics in children and adolescents with Tourette syndrome (TS) must be paralleled by changes in the underlying pathophysiology. Electrophysiological methods such as EEG and event-related potentials (ERPs) are non-invasive, safe and easy to apply and thus seem to provide an adequate means to investigate brain dynamics during this brain maturational period. Also, electrophysiology is characterized by a high time resolution and can reflect motor, sensory and cognitive aspects as well as sleep behavior. Hence, this narrative review focuses on how electrophysiology echoes brain dynamics during development of youngsters with TS and might be useful for the treatment of tics. A comprehensive picture of developmental brain dynamics could be revealed showing that electrophysiological parameters evolve concurrently with clinical characteristics of TS. Specifically, evidence for a maturational delay of motor inhibition related to cortico-spinal hyper-excitability and brain mechanisms for its cognitive compensation could be shown. Moreover, deviant sleep parameters and probably a stronger perception-action binding were reported. For neuromodulatory treatments (e.g., neurofeedback; repetitive transcranial magnetic stimulation, rTMS/transcranial direct current stimulation, tDCS) targeting neuronal deficits and/or strengthening compensatory brain mechanisms, pilot studies support the possibility of positive effects regarding tic reduction. Finally, attention-deficit/hyperactivity disorder (ADHD), as a highly frequent co-existing disorder with TS, has to be considered when using and interpreting electrophysiological measures in TS. In conclusion, application of electrophysiology seems to be promising regarding clinical and research aspects in youngsters with TS.
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Affiliation(s)
- Aribert Rothenberger
- Clinic for Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany
| | - Hartmut Heinrich
- neuroCare Group, Munich, Germany.,kbo-Heckscher-Klinikum, Munich, Germany.,Research Institute Brainclinics, Brainclinics Foundation, Nijmegen, Netherlands
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6
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Isaacs DA, Riordan HR, Claassen DO. Clinical Correlates of Health-Related Quality of Life in Adults With Chronic Tic Disorder. Front Psychiatry 2021; 12:619854. [PMID: 33776814 PMCID: PMC7987653 DOI: 10.3389/fpsyt.2021.619854] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 02/15/2021] [Indexed: 11/30/2022] Open
Abstract
Tics are the hallmark feature of Tourette syndrome (TS), but psychiatric and sensory symptoms are widely prevalent and increasingly recognized as core manifestations of the disorder. Accumulating evidence suggests that these psychiatric and sensory symptoms exert greater influence on quality of life (QOL) than tics themselves. However, much remains uncertain about determinants of QOL in TS due to the complexity of the clinical presentation. Here, we sought to clarify the association between health-related QOL (HRQOL) and common psychiatric and sensory symptoms in adults with TS and other chronic tic disorders. To do so, we prospectively recruited 52 patients from a tertiary care clinic to complete self-report measures assessing HRQOL (Gilles de la Tourette-Quality of Life Scale, GTS-QOL), depression (Patient Health Questionnaire-9, PHQ-9), anxiety (Generalized Anxiety Disorder Scale-7, GAD-7), obsessive-compulsive symptoms (Dimensional Obsessive-Compulsive Scale, DOCS), attention deficit hyperactivity disorder symptoms (Adult ADHD Self-Report Screening Scale for DSM-5, ASRS-V), and premonitory urge (Premonitory Urge to Tic Scale, PUTS). All participants were also administered the Yale Global Tic Severity Scale (YGTSS) to quantify tic severity. Using correlational analysis and multivariable linear regression modeling, we found that GTS-QOL score was significantly associated with scores from all other rating scales, with the exception of the PUTS. GTS-QOL was most strongly associated with PHQ-9, followed by ASRS-V, GAD-7, DOCS, and YGTSS total tic score. The regression model including these five independent variables, as well as sex, explained 79% of GTS-QOL score variance [F (6,40) = 29.6, p < 0.001]. Specific psychiatric symptoms differentially impacted physical, psychological, and cognitive HRQOL. Systematic assessment of psychiatric comorbidities is imperative for clinical care and clinical research efforts directed at improving QOL in adults with chronic tic disorders.
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Affiliation(s)
- David A Isaacs
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, United States.,Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, United States
| | - Heather R Riordan
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, United States.,Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, United States
| | - Daniel O Claassen
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, United States
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Openneer TJC, Forde NJ, Akkermans SEA, Naaijen J, Buitelaar JK, Hoekstra PJ, Dietrich A. Executive function in children with Tourette syndrome and attention-deficit/hyperactivity disorder: Cross-disorder or unique impairments? Cortex 2020; 124:176-187. [PMID: 31901563 DOI: 10.1016/j.cortex.2019.11.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 09/30/2019] [Accepted: 11/19/2019] [Indexed: 01/19/2023]
Abstract
Findings of executive functioning deficits in Tourette syndrome (TS) have so far been inconsistent, possibly due to methodological challenges of previous studies, such as the use of small sample sizes and not accounting for comorbid attention-deficit/hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), or medication use. We aimed to address these issues by examining several areas of executive functioning (response inhibition, attentional flexibility, cognitive control, and working memory) and psychomotor speed in 174 8-to-12-year-old children with TS [n = 34 without (TS-ADHD) and n = 26 with comorbid ADHD (TS+ADHD)], ADHD without tics (ADHD-TS; n = 54), and healthy controls (n = 60). We compared executive functioning measures and psychomotor speed between these groups and related these to ADHD severity across the whole sample, and tic severity across the TS groups. Children with TS+ADHD, but not TS-ADHD, made more errors on the cognitive control task than healthy children, while TS-ADHD had a slower psychomotor speed compared to healthy controls. The ADHD group showed impairment in cognitive control and working memory versus healthy controls. Moreover, higher ADHD severity was associated with poorer cognitive control and working memory across all groups; there was no relation between any of the executive functioning measures and tic severity. OCD severity or medication use did not influence our results. In conclusion, we found little evidence for executive function impairments inherent to TS. Executive function problems appear to manifest predominantly in relation to ADHD symptomatology, with both cross-disorder and unique features of neuropsychological functioning when cross-comparing TS and ADHD.
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Affiliation(s)
- Thaïra J C Openneer
- University of Groningen, University Medical Center Groningen, Department of Child and Adolescent Psychiatry, Groningen, the Netherlands.
| | - Natalie J Forde
- University of Groningen, University Medical Center Groningen, Department of Child and Adolescent Psychiatry, Groningen, the Netherlands; Department of Cognitive Neuroscience, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands; Center for Cognitive Neuroimaging, Radboud University, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands
| | - Sophie E A Akkermans
- Department of Cognitive Neuroscience, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands; Center for Cognitive Neuroimaging, Radboud University, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands
| | - Jilly Naaijen
- Department of Cognitive Neuroscience, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands; Center for Cognitive Neuroimaging, Radboud University, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands
| | - Jan K Buitelaar
- Department of Cognitive Neuroscience, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands; Center for Cognitive Neuroimaging, Radboud University, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands; Karakter Child and Adolescent Psychiatry, University Center, Nijmegen, the Netherlands
| | - Pieter J Hoekstra
- University of Groningen, University Medical Center Groningen, Department of Child and Adolescent Psychiatry, Groningen, the Netherlands
| | - Andrea Dietrich
- University of Groningen, University Medical Center Groningen, Department of Child and Adolescent Psychiatry, Groningen, the Netherlands
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Chutko LS, Surushkina SY, Yakovenko EA, Anisimova TI, Didur MD, Chekalova SA. [Cognitive disturbances in children with chronic tics and their treatment]. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 119:24-31. [PMID: 31626167 DOI: 10.17116/jnevro201911908124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To clarify the severity of cognitive disturbances in children with chronic tics and to evaluate the efficacy of cortexin as part of complex therapy in the treatment of this pathology. MATERIAL AND METHODS The main study group included 50 children, aged 6-8 years, with chronic motor tics. Twenty patients of these group received phenibut and 30 patients received cortexin in addition to phenibut. The comparison group consisted of 30 children with transient tics, aged 6-8 years, the control group consisted of 40 children of the same age without tics and other neuropsychiatric disorders. Clinical assessment of tick manifestations and their frequency was performed using the Tourette Syndrome Global Scale (TSGS), neurological examination, electroencephalography. Severity of asthenic and cognitive disorders was evaluated using the Subjective Asthenia Scale (MFI-20), the memorization technique by A.R. Luria and the TOVA test. RESULTS AND CONCLUSION Children with chronic tics show signs of asthenia, they are characterized by a higher level of inattention and significantly lower levels of long-term memory compared to children from the comparison group and the control group. The level of impulsivity in children with chronic tics is significantly higher than in the control group but significantly lower than in children in the comparison group. A comparative analysis of EEG data in children with chronic tics reveals the following significant differences from the control and comparison groups: a higher amplitude and higher values of the peak frequency of the alpha-rhythm in the posterior regions of both hemispheres, a significant increase in the alpha-range of the frontal temporal leads of both hemispheres. Complex therapy with the addition of cortexin significantly improves treatment efficacy: improvement is noted in 60,0% of patients in monotherapy and in 83.3% of patients in complex therapy.
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Affiliation(s)
- L S Chutko
- N. Bekhtereva Institute of Human Brain Russian Academy of Sciences, St. Petersburg, Russia
| | - S Yu Surushkina
- N. Bekhtereva Institute of Human Brain Russian Academy of Sciences, St. Petersburg, Russia
| | - E A Yakovenko
- N. Bekhtereva Institute of Human Brain Russian Academy of Sciences, St. Petersburg, Russia
| | - T I Anisimova
- N. Bekhtereva Institute of Human Brain Russian Academy of Sciences, St. Petersburg, Russia
| | - M D Didur
- N. Bekhtereva Institute of Human Brain Russian Academy of Sciences, St. Petersburg, Russia
| | - S A Chekalova
- Privolzhsky Research Medical University, Nizny Novgorod,Russia
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9
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Shephard E, Groom MJ, Jackson GM. Implicit sequence learning in young people with Tourette syndrome with and without co-occurring attention-deficit/hyperactivity disorder. J Neuropsychol 2018; 13:529-549. [PMID: 29972622 DOI: 10.1111/jnp.12167] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 10/30/2018] [Indexed: 11/30/2022]
Abstract
Impaired habit-learning has been proposed to underlie the tic symptoms of Tourette syndrome (TS). However, accounts differ in terms of how habit-learning is altered in TS, with some authors proposing habit formation is impaired due to a deficient 'chunking' mechanism, and others proposing habit-learning is overactive and tics reflect hyperlearned behaviours. Attention-deficit/hyperactivity disorder (ADHD) frequently co-occurs with TS and is known to affect cognitive function in young people with co-occurring TS and ADHD (TS + ADHD). It is unclear, however, how co-occurring ADHD symptoms affect habit-learning in TS. In this study, we investigated whether young people with TS would show deficient or hyperactive habit-learning, and assessed the effects of co-occurring ADHD symptoms on habit-learning in TS. Participants aged 9-17 years with TS (n = 18), TS + ADHD (n = 17), ADHD (n = 13), and typical development (n = 20) completed a motor sequence learning task to assess habit-learning. We used a 2 (TS-yes, TS-no) × 2 (ADHD-yes, ADHD-no) factorial analysis to test the effects of TS, ADHD, and their interaction on accuracy and reaction time indices of sequence learning. TS was associated with intact sequence learning, but a tendency for difficulty transitioning from sequenced to non-sequenced performance was suggestive of hyper-learning. ADHD was associated with significantly poorer accuracy during acquisition of the sequence, indicative of impaired habit-learning. There were no interactions between the TS and ADHD factors, indicating young people with TS + ADHD showed both TS- and ADHD-related atypicalities in habit-learning.
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Affiliation(s)
- Elizabeth Shephard
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology, & Neuroscience, King's College London, UK
| | - Madeleine J Groom
- Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham, UK
| | - Georgina M Jackson
- Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham, UK
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Morand-Beaulieu S, Leclerc JB, Valois P, Lavoie ME, O'Connor KP, Gauthier B. A Review of the Neuropsychological Dimensions of Tourette Syndrome. Brain Sci 2017; 7:E106. [PMID: 28820427 PMCID: PMC5575626 DOI: 10.3390/brainsci7080106] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 08/10/2017] [Accepted: 08/15/2017] [Indexed: 11/29/2022] Open
Abstract
Neurocognitive functioning in Tourette syndrome (TS) has been the subject of intensive research in the past 30 years. A variety of impairments, presumably related to frontal and frontostriatal dysfunctions, have been observed. These impairments were found in various domains, such as attention, memory, executive functions, language, motor and visuomotor functions, among others. In line with contemporary research, other neurocognitive domains have recently been explored in TS, bringing evidence of altered social reasoning, for instance. Therefore, the aims of this review are to give an overview of the neuropsychological dimensions of TS, to report how neuropsychological functions evolve from childhood to adulthood, and to explain how various confounding factors can affect TS patients' performance in neuropsychological tasks. Finally, an important contribution of this review is to show how recent research has confirmed or changed our beliefs about neuropsychological functioning in TS.
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Affiliation(s)
- Simon Morand-Beaulieu
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, 7331 rue Hochelaga, Montréal, QC H1N 3V2, Canada.
- Département de neurosciences, Université de Montréal, 2960 Chemin de la Tour, Montréal, QC H3T 1J4, Canada.
| | - Julie B Leclerc
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, 7331 rue Hochelaga, Montréal, QC H1N 3V2, Canada.
- Département de psychologie, Université du Québec à Montréal, 100, rue Sherbrooke Ouest, Montréal, QC H2X 3P2, Canada.
| | - Philippe Valois
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, 7331 rue Hochelaga, Montréal, QC H1N 3V2, Canada.
- Département de psychologie, Université du Québec à Montréal, 100, rue Sherbrooke Ouest, Montréal, QC H2X 3P2, Canada.
| | - Marc E Lavoie
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, 7331 rue Hochelaga, Montréal, QC H1N 3V2, Canada.
- Département de neurosciences, Université de Montréal, 2960 Chemin de la Tour, Montréal, QC H3T 1J4, Canada.
- Département de psychiatrie, Université de Montréal, 2900, boulevard Édouard-Montpetit, Montréal, QC H3T 1J4, Canada.
| | - Kieron P O'Connor
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, 7331 rue Hochelaga, Montréal, QC H1N 3V2, Canada.
- Département de psychologie, Université du Québec à Montréal, 100, rue Sherbrooke Ouest, Montréal, QC H2X 3P2, Canada.
- Département de psychiatrie, Université de Montréal, 2900, boulevard Édouard-Montpetit, Montréal, QC H3T 1J4, Canada.
| | - Bruno Gauthier
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, 7331 rue Hochelaga, Montréal, QC H1N 3V2, Canada.
- Département de psychologie, Université de Montréal, Campus Laval, 1700 rue Jacques-Tétreault, Laval, QC H7N 0B6, Canada.
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Eichele H, Eichele T, Marquardt L, Adolfsdottir S, Hugdahl K, Sørensen L, Plessen KJ. Development of Performance and ERPs in a Flanker Task in Children and Adolescents with Tourette Syndrome-A Follow-Up Study. Front Neurosci 2017; 11:305. [PMID: 28659750 PMCID: PMC5466959 DOI: 10.3389/fnins.2017.00305] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 05/16/2017] [Indexed: 01/21/2023] Open
Abstract
Background: Tourette Syndrome (TS) is a neurodevelopmental disorder with childhood-onset, with a typical decline in tic severity, as well as an increasing ability to suppress tics in late childhood and adolescence. These processes develop in parallel with general improvement of self-regulatory abilities, and performance monitoring during this age-span. Hence, changes in performance monitoring over time might provide insight into the regulation of tics in children and adolescents with TS. Method: We measured reaction time, reaction time variability, accuracy, and event-related potentials (ERP) in 17 children with TS, including 10 children with comorbid Attention-Deficit/Hyperactivity Disorder (ADHD), 24 children with ADHD, and 29 typically developing children, using a modified Eriksen Flanker task in two testing sessions administered on average 4.5 years apart. We then compared task performance, as well as ERP components across groups, and over time using regression models. Results: Task performance improved in all groups with age, and behavioral differences between children with TS and controls diminished at second assessment, while differences between controls and children with ADHD largely persisted. In terms of ERP, the early P3 developed earlier in children with TS compared with controls at the first assessment, but trajectories converged with maturation. ERP component amplitudes correlated with worst-ever tic scores. Conclusions: Merging trajectories between children with TS and controls are consistent with the development of compensatory self-regulation mechanisms during early adolescence, probably facilitating tic suppression, in contrast to children with ADHD. Correlations between ERP amplitudes and tic scores also support this notion.
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Affiliation(s)
- Heike Eichele
- Department of Biological and Medical Psychology, University of BergenBergen, Norway
| | - Tom Eichele
- Department of Biological and Medical Psychology, University of BergenBergen, Norway.,K.G. Jebsen Centre for Research on Neuropsychiatric Disorders, University of BergenBergen, Norway.,Section for Neurophysiology, Department of Neurology, Haukeland University HospitalBergen, Norway
| | - Lynn Marquardt
- Department of Biological and Medical Psychology, University of BergenBergen, Norway
| | | | - Kenneth Hugdahl
- Department of Biological and Medical Psychology, University of BergenBergen, Norway.,K.G. Jebsen Centre for Research on Neuropsychiatric Disorders, University of BergenBergen, Norway.,Division of Psychiatry, Haukeland University HospitalBergen, Norway
| | - Lin Sørensen
- Department of Biological and Medical Psychology, University of BergenBergen, Norway.,K.G. Jebsen Centre for Research on Neuropsychiatric Disorders, University of BergenBergen, Norway
| | - Kerstin J Plessen
- K.G. Jebsen Centre for Research on Neuropsychiatric Disorders, University of BergenBergen, Norway.,Child and Adolescent Mental Health Center, Mental Health Services Capital RegionCopenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of CopenhagenCopenhagen, Denmark
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12
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Uebel-von Sandersleben H, Albrecht B, Rothenberger A, Fillmer-Heise A, Roessner V, Sergeant J, Tannock R, Banaschewski T. Revisiting the co-existence of Attention-Deficit/Hyperactivity Disorder and Chronic Tic Disorder in childhood-The case of colour discrimination, sustained attention and interference control. PLoS One 2017; 12:e0178866. [PMID: 28594866 PMCID: PMC5464598 DOI: 10.1371/journal.pone.0178866] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 05/19/2017] [Indexed: 01/28/2023] Open
Abstract
Objective Attention Deficit / Hyperactivity Disorder (ADHD) and Chronic Tic Disorder (CTD) are two common and frequently co-existing disorders, probably following an additive model. But this is not yet clear for the basic sensory function of colour processing sensitive to dopaminergic functioning in the retina and higher cognitive functions like attention and interference control. The latter two reflect important aspects for psychoeducation and behavioural treatment approaches. Methods Colour discrimination using the Farnsworth-Munsell 100-hue Test, sustained attention during the Frankfurt Attention Inventory (FAIR), and interference liability during Colour- and Counting-Stroop-Tests were assessed to further clarify the cognitive profile of the co-existence of ADHD and CTD. Altogether 69 children were classified into four groups: ADHD (N = 14), CTD (N = 20), ADHD+CTD (N = 20) and healthy Controls (N = 15) and compared in cognitive functioning in a 2×2-factorial statistical model. Results Difficulties with colour discrimination were associated with both ADHD and CTD factors following an additive model, but in ADHD these difficulties tended to be more pronounced on the blue-yellow axis. Attention problems were characteristic for ADHD but not CTD. Interference load was significant in both Colour- and Counting-Stroop-Tests and unrelated to colour discrimination. Compared to Controls, interference load in the Colour-Stroop was higher in pure ADHD and in pure CTD, but not in ADHD+CTD, following a sub-additive model. In contrast, interference load in the Counting-Stroop did not reveal ADHD or CTD effects. Conclusion The co-existence of ADHD and CTD is characterized by additive as well as sub-additive performance impairments, suggesting that their co-existence may show simple additive characteristics of both disorders or a more complex interaction, depending on demand. The equivocal findings on interference control may indicate limited validity of the Stroop-Paradigm for clinical assessments.
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Affiliation(s)
| | - Björn Albrecht
- Child and Adolescent Psychiatry, University Medical Center Göttingen, Göttingen, Germany
| | - Aribert Rothenberger
- Child and Adolescent Psychiatry, University Medical Center Göttingen, Göttingen, Germany
| | - Anke Fillmer-Heise
- Child and Adolescent Psychiatry, University Medical Center Göttingen, Göttingen, Germany
| | - Veit Roessner
- Department of Child and Adolescent Psychiatry, Technische Universität Dresden, Dresden, Germany
| | - Joseph Sergeant
- Department of Clinical Neuropsychology, Faculteit der Psychologie, Vrije University, Amsterdam, The Netherlands
| | | | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health Mannheim, Mannheim, Germany
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13
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Morand-Beaulieu S, Grot S, Lavoie J, Leclerc JB, Luck D, Lavoie ME. The puzzling question of inhibitory control in Tourette syndrome: A meta-analysis. Neurosci Biobehav Rev 2017; 80:240-262. [PMID: 28502600 DOI: 10.1016/j.neubiorev.2017.05.006] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 05/04/2017] [Accepted: 05/08/2017] [Indexed: 02/02/2023]
Abstract
Tourette syndrome (TS) is a neuropsychiatric disorder involving motor and phonic tics. Inhibitory control is a key issue in TS, and many disruptive or impulsive behaviors might arise from inhibitory deficits. However, conflicting findings regarding TS patients' inhibitory performance in neuropsychological tasks have been reported throughout the literature. Therefore, this meta-analysis aimed to evaluate inhibitory control through neuropsychological tasks, and to analyze the factors modulating inhibitory deficits. To this end, a literature search was performed through MEDLINE and PsycINFO, to retrieve studies including neuropsychological tasks that assessed inhibitory control in TS patients. Of the 4020 studies identified, 61 were included in the meta-analysis, for a total of 1717 TS patients. Our analyses revealed a small to medium effect in favor of inhibitory deficits in TS patients. This effect was larger in TS+ADHD patients, but pure TS patients also showed some inhibitory deficits. Therefore, deficits in inhibitory control seem to be an inherent component of TS, and are exacerbated when ADHD is concomitant.
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Affiliation(s)
- Simon Morand-Beaulieu
- Cognitive and Social Psychophysiology Lab, Montreal, Qc, Canada; Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montreal, Qc, Canada; Département de neurosciences, Université de Montréal, Montreal, Qc, Canada.
| | - Stéphanie Grot
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montreal, Qc, Canada; Département de psychiatrie, Université de Montréal, Montreal, Qc, Canada.
| | - Jacob Lavoie
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montreal, Qc, Canada; Département de neurosciences, Université de Montréal, Montreal, Qc, Canada.
| | - Julie B Leclerc
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montreal, Qc, Canada; Département de psychologie, Université du Québec à Montréal, Montreal, Qc, Canada.
| | - David Luck
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montreal, Qc, Canada; Département de neurosciences, Université de Montréal, Montreal, Qc, Canada; Département de psychiatrie, Université de Montréal, Montreal, Qc, Canada.
| | - Marc E Lavoie
- Cognitive and Social Psychophysiology Lab, Montreal, Qc, Canada; Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montreal, Qc, Canada; Département de neurosciences, Université de Montréal, Montreal, Qc, Canada; Département de psychiatrie, Université de Montréal, Montreal, Qc, Canada.
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14
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Kim WH, Park TW, Park J, Chung SK, Yang JC, Park JI, Kim EJ, Cho EC, Park JC. Comparing Intelligence Test Profiles to Assess Tourette’s Disorder with Attention-Deficit Hyperactivity Disorder. Soa Chongsonyon Chongsin Uihak 2017. [DOI: 10.5765/jkacap.2017.28.1.25] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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15
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Termine C, Luoni C, Fontolan S, Selvini C, Perego L, Pavone F, Rossi G, Balottin U, Cavanna AE. Impact of co-morbid attention-deficit and hyperactivity disorder on cognitive function in male children with Tourette syndrome: A controlled study. Psychiatry Res 2016; 243:263-7. [PMID: 27423633 DOI: 10.1016/j.psychres.2016.06.048] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Revised: 04/18/2016] [Accepted: 06/26/2016] [Indexed: 11/30/2022]
Abstract
Tourette syndrome (TS) and attention-deficit and hyperactivity disorder (ADHD) are co-morbid neurodevelopmental conditions affecting more commonly male patients. We set out to determine the impact of co-morbid ADHD on cognitive function in male children with TS by conducting a controlled study. Participants included four matched groups of unmedicated children (age range 6-15 years): TS (n=13), TS+ADHD (n=8), ADHD (n=39), healthy controls (n=66). Following clinical assessment, each participant completed a battery of tests from the Wechsler Intelligence Scale for Children-III, the Italian Battery for ADHD, the Tower of London test, the Corsi test, and the Digit Span test. All patient groups reported significantly lower scores than healthy controls across the neuropsychological tests involving executive functions. The TS+ADHD group was the most severely affected, followed by the ADHD group and the TS group, particularly in the tests assessing planning ability, inhibitory function, working memory and visual attention, but not auditory attention. Problems in executive functions are more common in patients with neurodevelopmental disorders than controls. Deficits in planning ability, inhibitory function, working memory and visual attention reported by children with TS appear to be more strongly related to the presence of co-morbid ADHD symptoms than core TS symptoms.
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Affiliation(s)
- Cristiano Termine
- Child Neuropsychiatry Unit, Department of Experimental Medicine, University of Insubria, Varese, Italy; Child Neuropsychiatry Unit, Ospedale di Circolo & Macchi Foundation, Varese, Italy
| | - Chiara Luoni
- Child Neuropsychiatry Unit, Department of Experimental Medicine, University of Insubria, Varese, Italy
| | - Stefania Fontolan
- Child Neuropsychiatry Unit, Department of Experimental Medicine, University of Insubria, Varese, Italy
| | - Claudia Selvini
- Child Neuropsychiatry Unit, Department of Experimental Medicine, University of Insubria, Varese, Italy
| | - Livia Perego
- Child Neuropsychiatry Unit, Department of Experimental Medicine, University of Insubria, Varese, Italy
| | - Francesca Pavone
- Child Neuropsychiatry Unit, Ospedale di Circolo & Macchi Foundation, Varese, Italy
| | - Giorgio Rossi
- Child Neuropsychiatry Unit, Ospedale di Circolo & Macchi Foundation, Varese, Italy
| | - Umberto Balottin
- Department of Child Neurology and Psychiatry, IRCCS "C. Mondino" Foundation, University of Pavia, Italy
| | - Andrea E Cavanna
- Department of Neuropsychiatry, BSMHFT and University of Birmingham, United Kingdom; School of Life and Health Sciences, Aston University, Birmingham, United Kingdom; Sobell Department of Motor Neuroscience and Movement Disorders, UCL and Institute of Neurology, London, United Kingdom.
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16
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Shephard E, Jackson GM, Groom MJ. Electrophysiological correlates of reinforcement learning in young people with Tourette syndrome with and without co-occurring ADHD symptoms. Int J Dev Neurosci 2016; 51:17-27. [PMID: 27103231 DOI: 10.1016/j.ijdevneu.2016.04.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 04/14/2016] [Indexed: 01/28/2023] Open
Abstract
Altered reinforcement learning is implicated in the causes of Tourette syndrome (TS) and attention-deficit/hyperactivity disorder (ADHD). TS and ADHD frequently co-occur but how this affects reinforcement learning has not been investigated. We examined the ability of young people with TS (n=18), TS+ADHD (N=17), ADHD (n=13) and typically developing controls (n=20) to learn and reverse stimulus-response (S-R) associations based on positive and negative reinforcement feedback. We used a 2 (TS-yes, TS-no)×2 (ADHD-yes, ADHD-no) factorial design to assess the effects of TS, ADHD, and their interaction on behavioural (accuracy, RT) and event-related potential (stimulus-locked P3, feedback-locked P2, feedback-related negativity, FRN) indices of learning and reversing the S-R associations. TS was associated with intact learning and reversal performance and largely typical ERP amplitudes. ADHD was associated with lower accuracy during S-R learning and impaired reversal learning (significantly reduced accuracy and a trend for smaller P3 amplitude). The results indicate that co-occurring ADHD symptoms impair reversal learning in TS+ADHD. The implications of these findings for behavioural tic therapies are discussed.
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Affiliation(s)
- Elizabeth Shephard
- MRC Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, & Neuroscience (IoPPN), King's College London, 16 De Crespigny Park, Denmark Hill, London, SE5 8AF, UK.
| | - Georgina M Jackson
- Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham, Jubilee Campus, Triumph Road, Nottingham, NG7 2TU, UK.
| | - Madeleine J Groom
- Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham, Jubilee Campus, Triumph Road, Nottingham, NG7 2TU, UK.
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17
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Shephard E, Jackson GM, Groom MJ. WITHDRAWN: Electrophysiological correlates of reinforcement learning in young people with Tourette syndrome with and without co-occurring ADHD symptoms. Int J Dev Neurosci 2016:S0736-5748(15)30159-3. [PMID: 27103230 DOI: 10.1016/j.ijdevneu.2016.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 04/15/2016] [Accepted: 04/16/2016] [Indexed: 11/27/2022] Open
Abstract
The Publisher regrets that this article is an accidental duplication of an article that has already been published, http://dx.doi.org/10.1016/j.ijdevneu.2016.04.006. The duplicate article has therefore been withdrawn. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.
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Affiliation(s)
- Elizabeth Shephard
- MRC Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, & Neuroscience (IoPPN), King's College London, 16 De Crespigny Park, Denmark Hill, London SE5 8AF, UK.
| | - Georgina M Jackson
- Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham, Jubilee Campus, Triumph Road, Nottingham NG7 2TU, UK.
| | - Madeleine J Groom
- Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham, Jubilee Campus, Triumph Road, Nottingham NG7 2TU, UK.
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18
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Eichele H, Eichele T, Bjelland I, Høvik MF, Sørensen L, van Wageningen H, Worren MK, Hugdahl K, Plessen KJ. Performance Monitoring in Medication-Naïve Children with Tourette Syndrome. Front Neurosci 2016; 10:50. [PMID: 26973443 PMCID: PMC4771943 DOI: 10.3389/fnins.2016.00050] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 02/04/2016] [Indexed: 01/08/2023] Open
Abstract
Background: Tourette syndrome (TS) is a childhood-onset neurodevelopmental disorder and its impact on cognitive development needs further study. Evidence from neuropsychological, neuroimaging and electrophysiological studies suggests that the decline in tic severity and the ability to suppress tics relate to the development of self-regulatory functions in late childhood and adolescence. Hence, tasks measuring performance monitoring might provide insight into the regulation of tics in children with TS. Method: Twenty-five children with TS, including 14 with comorbid Attention-deficit/ hyperactivity disorder (ADHD), 39 children with ADHD and 35 typically developing children aged 8–12 years were tested with a modified Eriksen-Flanker task during a 34-channel electroencephalography (EEG) recording. Task performance, as well as stimulus-locked and response-locked event-related potentials (ERP) were analyzed and compared across groups. Results: Participants did not differ in their behavioral performance. Children with TS showed higher amplitudes of an early P3 component of the stimulus-locked ERPs in ensemble averages and in separate trial outcomes, suggesting heightened orienting and/or attention during stimulus evaluation. In response-locked averages, children with TS had a slightly higher positive complex before the motor response, likely also reflecting a late P3. Groups did not differ in post-response components, particularly in the error-related negativity (ERN) and error-related positivity (Pe). Conclusions: These findings suggest that children with TS may employ additional attentional resources as a compensatory mechanism to maintain equal behavioral performance.
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Affiliation(s)
- Heike Eichele
- Department of Biological and Medical Psychology, University of Bergen Bergen, Norway
| | - Tom Eichele
- Department of Biological and Medical Psychology, University of BergenBergen, Norway; K.G. Jebsen Centre for Research on Neuropsychiatric Disorders, University of BergenBergen, Norway; Section for Neurophysiology, Department of Neurology, Haukeland University HospitalBergen, Norway
| | - Ingvar Bjelland
- Department of Psychiatry, Haukeland University HospitalBergen, Norway; Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of BergenBergen, Norway
| | - Marie F Høvik
- Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen Bergen, Norway
| | - Lin Sørensen
- Department of Biological and Medical Psychology, University of Bergen Bergen, Norway
| | - Heidi van Wageningen
- Department of Biological and Medical Psychology, University of Bergen Bergen, Norway
| | - Marius Kalsås Worren
- Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen Bergen, Norway
| | - Kenneth Hugdahl
- Department of Biological and Medical Psychology, University of BergenBergen, Norway; K.G. Jebsen Centre for Research on Neuropsychiatric Disorders, University of BergenBergen, Norway; Department of Psychiatry, Haukeland University HospitalBergen, Norway
| | - Kerstin J Plessen
- K.G. Jebsen Centre for Research on Neuropsychiatric Disorders, University of BergenBergen, Norway; Child and Adolescent Mental Health Center, Mental Health Services Capital RegionCopenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of CopenhagenCopenhagen, Denmark
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19
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Shephard E, Jackson GM, Groom MJ. The effects of co-occurring ADHD symptoms on electrophysiological correlates of cognitive control in young people with Tourette syndrome. J Neuropsychol 2015; 10:223-38. [PMID: 25894525 DOI: 10.1111/jnp.12071] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 03/26/2015] [Indexed: 11/26/2022]
Abstract
Efficient cognitive control is implicated in tic control in young people with Tourette syndrome (TS). Attention-deficit/hyperactivity disorder (ADHD) frequently co-occurs with TS and is associated with impaired cognitive control. Young people with TS and ADHD (TS+ADHD) show poorer cognitive control performance than those with TS, but how co-occurring ADHD affects underlying neural activity is unknown. We investigated this issue by examining behavioural and event-related potential (ERP) correlates of cognitive control in young people with these conditions. Participants aged 9-17 with TS (n = 17), TS+ADHD (n = 17), ADHD (n = 11), and unaffected controls (n = 20) performed a visual Go/Nogo task during electroencephalography (EEG) recording. Behavioural performance measures (D-prime, RT, reaction time variability, post-error slowing) and ERP measures (N2, P3, error-related negativity (ERN), error positivity (Pe)) were analysed in a 2 (TS-yes, TS-no) × 2 (ADHD-yes, ADHD-no) factorial analysis to investigate the effects of TS, ADHD, and their interaction. The results of these analyses showed that ADHD was associated with poorer performance and reduced amplitude of all ERPs, reflecting widespread cognitive control impairments. Tourette syndrome was associated with slowed RTs, which might reflect a compensatory slowing of motor output to facilitate tic control. There was no interaction between the TS and ADHD factors for any behavioural or ERP measure, indicating the impairing effects of ADHD on behaviour and electrophysiological markers of cognitive control were present in TS+ADHD and that RT slowing associated with TS was unaffected by co-occurring ADHD symptoms.
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Affiliation(s)
- Elizabeth Shephard
- Department of Psychology, Institute of Psychiatry, Psychology, & Neuroscience, King's College London, UK
| | - Georgina M Jackson
- Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham, UK
| | - Madeleine J Groom
- Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham, UK
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20
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Bachmann CJ, Roessner V, Glaeske G, Hoffmann F. Trends in psychopharmacologic treatment of tic disorders in children and adolescents in Germany. Eur Child Adolesc Psychiatry 2015; 24:199-207. [PMID: 24888751 DOI: 10.1007/s00787-014-0563-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Accepted: 05/15/2014] [Indexed: 10/25/2022]
Abstract
Data on medical treatment of children and adolescents with tic disorders are scarce. This study examined the administrative prevalence of psychopharmacological prescriptions in this patient group in Germany. Data of the largest German health insurance fund were analysed. In outpatients aged 0-19 years with diagnosed tic disorder, psychotropic prescriptions were evaluated for the years 2006 and 2011. In 2011, the percentage of psychotropic prescriptions was slightly higher than in 2006 (21.2 vs. 18.6%). The highest prescription prevalence was found in Tourette syndrome (51.5 and 53.0%, respectively). ADHD drugs were most frequently prescribed, followed by antipsychotics. In 2011, prescriptions of second generation antipsychotics (SGA) were higher and prescriptions of first generation antipsychotics (FGA) lower than in 2006. Concerning prescribed antipsychotic substances, in 2011 risperidone prescriptions were higher and tiapride prescriptions lower. Paediatricians issued 37.4%, and child and adolescent psychiatrists issued 37.1% of psychotropic prescriptions. The FGA/SGA ratio was highest in GPs (1.25) and lowest in child and adolescent psychiatrists (0.96). From 2006 to 2011, there was only a slight increase in psychotropic prescriptions for children and adolescents with a diagnosis of tic disorder in Germany, which stands in contrast towards the significant increase in psychotropic prescriptions in other child and adolescent psychiatric disorders (e.g. ADHD). There were marked differences in treatment patterns by tic disorder subgroups, with Tourette syndrome patients receiving most frequently psychopharmacotherapy. Risperidone prescriptions increased, probably reflecting a switch in prescribing practice towards up-to-date treatment guidelines. In primary care physicians, dissemination of current tic disorder treatment guidelines might constitute an important educational goal.
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Affiliation(s)
- Christian J Bachmann
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Philipps-University Marburg, Schützenstr. 49, 35039, Marburg, Germany,
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21
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Ganos C, Kühn S, Kahl U, Schunke O, Feldheim J, Gerloff C, Roessner V, Bäumer T, Thomalla G, Haggard P, Münchau A. Action inhibition in Tourette syndrome. Mov Disord 2014; 29:1532-8. [DOI: 10.1002/mds.25944] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2013] [Revised: 04/30/2014] [Accepted: 05/28/2014] [Indexed: 11/09/2022] Open
Affiliation(s)
- Christos Ganos
- Department of Neurology; University Medical Center Hamburg-Eppendorf (UKE); Hamburg Germany
- Sobell Department of Motor Neuroscience and Movement Disorders; University College London Institute of Neurology; London United Kingdom
- Department of Paediatric and Adult Movement Disorders and Neuropsychiatry; Institute of Neurogenetics, University of Lübeck; Lübeck Germany
| | - Simone Kühn
- Center for Lifespan Psychology, Max Planck Institute for Human Development; Berlin Germany
| | - Ursula Kahl
- Department of Neurology; University Medical Center Hamburg-Eppendorf (UKE); Hamburg Germany
| | - Odette Schunke
- Department of Neurology; University Medical Center Hamburg-Eppendorf (UKE); Hamburg Germany
| | - Jan Feldheim
- Brain Imaging and Neurostimulation Laboratory; Department of Neurology; University Medical Center Hamburg-Eppendorf (UKE); Hamburg Germany
| | - Christian Gerloff
- Department of Neurology; University Medical Center Hamburg-Eppendorf (UKE); Hamburg Germany
| | - Veit Roessner
- Department of Child and Adolescent Psychiatry; University of Dresden Medical School; Dresden Germany
| | - Tobias Bäumer
- Department of Paediatric and Adult Movement Disorders and Neuropsychiatry; Institute of Neurogenetics, University of Lübeck; Lübeck Germany
| | - Götz Thomalla
- Department of Neurology; University Medical Center Hamburg-Eppendorf (UKE); Hamburg Germany
| | - Patrick Haggard
- Institute of Cognitive Neuroscience; University College London; United Kingdom
| | - Alexander Münchau
- Department of Paediatric and Adult Movement Disorders and Neuropsychiatry; Institute of Neurogenetics, University of Lübeck; Lübeck Germany
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22
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Rizzo R, Gulisano M, Calì PV, Curatolo P. Tourette Syndrome and comorbid ADHD: current pharmacological treatment options. Eur J Paediatr Neurol 2013; 17:421-8. [PMID: 23473832 DOI: 10.1016/j.ejpn.2013.01.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Revised: 12/30/2012] [Accepted: 01/26/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND Attention Deficit Hyperactivity Disorder (ADHD) is the most common co-morbid condition encountered in people with tics and Tourette Syndrome (TS). The co-occurrence of TS and ADHD is associated with a higher psychopathological, social and academic impairment and the management may represent a challenge for the clinicians. AIM To review recent advances in management of patients with tic, Tourette Syndrome and comorbid Attention Deficit Hyperactivity Disorder. METHODS We searched peer reviewed and original medical publications (PUBMED 1990-2012) and included randomized, double-blind, controlled trials related to pharmacological treatment for tic and TS used in children and adolescents with comorbid ADHD. "Tourette Syndrome" or "Tic" and "ADHD", were cross referenced with the words "pharmacological treatment", "α-agonist", "psychostimulants", "selective norepinephrine reuptake inhibitor", "antipsychotics". RESULTS Three classes of drugs are currently used in the treatment of TS and comorbid ADHD: α-agonists (clonidine and guanfacine), stimulants (amphetamine enantiomers, methylphenidate enantiomers or slow release preparation), and selective norepinephrine reuptake inhibitor (atomoxetine). It has been recently suggested that in a few selected cases partial dopamine agonists (aripiprazole) could be useful. CONCLUSION Level A of evidence supported the use of noradrenergic agents (clonidine). Reuptake inhibitors (atomoxetine) and stimulants (methylphenidate) could be, also used for the treatment of TS and comorbid ADHD. Taking into account the risk-benefit profile, clonidine could be used as the first line treatment. However only few studies meet rigorous quality criteria in terms of study design and methodology; most trials have low statistical power due to small sample size or short duration. Treatment should be "symptom targeted" and personalized for each patient.
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Affiliation(s)
- Renata Rizzo
- Section of Child Neuropsichiatry, Dipartimento di Scienze Mediche e Pediatriche, Catania University, Via Santa Sofia 78, 95123 Catania, Italy.
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Comorbidity and continuity of attention deficit hyperactivity disorder (ADHD) from childhood to adolescence in Turkey. ACTA ACUST UNITED AC 2013; 5:353-60. [PMID: 23893566 DOI: 10.1007/s12402-013-0114-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Accepted: 07/05/2013] [Indexed: 10/26/2022]
Abstract
The aim of this study was to examine clinical outcomes, psychiatric comorbidity and neuropsychological characteristics in Turkish adolescents with an attention deficit hyperactivity disorder (ADHD) diagnosis in childhood. A total of 45 children with ADHD diagnosis and 28 children with a psychiatric diagnosis other than ADHD in a 1-year cohort of 7-10-year-olds were reevaluated 6 years later using Schedule for Affective Disorders and Schizophrenia for School-Age Children Present and Lifetime version and Wechsler Intelligence Scale for Children-Revised and Stroop Test TBAG version. This study shows that the clinical outcomes and the comorbidity patterns for ADHD from childhood to adolescence in Turkey are similar to reported rates in the Western countries. In the ADHD group, 75.6 % still has impairing ADHD symptoms and 46.6 % has comorbid psychiatric disorders. The main difference is anxiety disorders being the most common comorbid disorders (37.8 %) in Turkish ADHD youth. These findings stress the high comorbidity associated with ADHD and support the importance of assessment and treatment for ADHD and comorbidities during adolescence.
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Buse J, Schoenefeld K, Münchau A, Roessner V. Neuromodulation in Tourette syndrome: Dopamine and beyond. Neurosci Biobehav Rev 2013; 37:1069-84. [DOI: 10.1016/j.neubiorev.2012.10.004] [Citation(s) in RCA: 136] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Revised: 09/28/2012] [Accepted: 10/08/2012] [Indexed: 01/11/2023]
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25
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Min JW, Lee WH, Hong MH, Bahn GH. A Pilot Study of the Usefulness of Intelligence Test in Assessment of Attention-Deficit Hyperactivity Disorder. Soa Chongsonyon Chongsin Uihak 2012. [DOI: 10.5765/jkacap.2012.23.4.196] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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26
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Roessner V, Schoenefeld K, Buse J, Wanderer S, Rothenberger A. Therapie der Tic-Störungen. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2012; 40:217-36; quiz 236-7. [DOI: 10.1024/1422-4917/a000176] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Seit dem Erscheinen unserer letzten Übersichtsarbeit zur «Therapie der Tic-Störungen» in der Zeitschrift für Kinder- und Jugendpsychiatrie wurden große Fortschritte auf diesem Gebiet erzielt. So wurden einzelne Bausteine auf dem Weg zur optimalen Behandlung konkretisiert, z. B. Veröffentlichung einheitlicher Kriterien zur Behandlungsindikation oder Entwicklung und Evaluierung eines detaillierten verhaltenstherapeutischen Manuals zum Habit-Reversal-Training. Daneben sind neue Therapiemöglichkeiten, wie das Medikament Aripiprazol oder die Tiefenhirnstimulation, erfolgreich implementiert worden. Auch wurde das Augenmerk viel stärker auf begleitende Störungen, wie ADHS und Zwangsstörungen, gerichtet, da diese in der Regel eine besonders starke Beeinträchtigung für die weitere Entwicklung des Kindes oder Jugendlichen darstellen. Dennoch bestehen weiterhin große Wissenslücken über die Effektivität der einzelnen Behandlungsmethoden, möglicher Kombinationsbehandlungen sowie deren direkter Vergleich untereinander. Daneben erschwert das Fehlen jeglicher Parameter zur Vorhersage der individuell sehr unterschiedlichen Entwicklung der Tics über die nächsten Monate und Jahre eine evidenzbasierte Therapieempfehlung und damit das Erlernen der Feinheiten bei der Behandlung von Tic-Störungen. Zusammengefasst ist noch immer eine große klinische Erfahrung für die Therapieentscheidungen beim einzelnen Patienten von großem Vorteil angesichts der enormen Bandbreite an individueller Tic-Symptomatik und Komorbidität gepaart mit den unvorhersehbaren Schwankungen im zeitlichen Verlauf.
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Affiliation(s)
- Veit Roessner
- Kinder- und Jugendpsychiatrie und Psychotherapie, Universität Dresden
| | - Katia Schoenefeld
- Kinder- und Jugendpsychiatrie und Psychotherapie, Universität Dresden
| | - Judith Buse
- Kinder- und Jugendpsychiatrie und Psychotherapie, Universität Dresden
| | - Sina Wanderer
- Kinder- und Jugendpsychiatrie und Psychotherapie, Universität Dresden
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Lin YJ, Lai MC, Gau SSF. Youths with ADHD with and without tic disorders: comorbid psychopathology, executive function and social adjustment. RESEARCH IN DEVELOPMENTAL DISABILITIES 2012; 33:951-963. [PMID: 22285732 DOI: 10.1016/j.ridd.2012.01.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Accepted: 01/04/2012] [Indexed: 05/31/2023]
Abstract
Attention deficit/hyperactivity disorder (ADHD) and tic disorders (TD) commonly co-occur. Clarifying the psychiatric comorbidities, executive functions and social adjustment difficulties in children and adolescents of ADHD with and without TD is informative to understand the developmental psychopathology and to identify their specific clinical needs. This matched case-control study compared three groups (n=40 each) of youths aged between 8 and 16 years: ADHD with co-occurring TD (ADHD+TD), ADHD without TD (ADHD-TD) and typically developing community controls. Both ADHD groups had more co-occurring oppositional defiant disorder than the control group, and the presence of TD was associated with more anxiety disorders. TD did not impose additional executive function impairments or social adjustment difficulties on ADHD. Interestingly, for youths with ADHD, the presence of TD was associated with less interpersonal difficulties at school, compared to those without TD. The potential various directions of effects from co-occurring TD should be carefully evaluated and investigated for youths with ADHD.
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Affiliation(s)
- Yu-Ju Lin
- Department of Psychiatry, Far Eastern Memorial Hospital, New Taipei City, Taiwan
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28
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Greimel E, Wanderer S, Rothenberger A, Herpertz-Dahlmann B, Konrad K, Roessner V. Attentional performance in children and adolescents with tic disorder and co-occurring attention-deficit/hyperactivity disorder: new insights from a 2 × 2 factorial design study. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2011; 39:819-28. [PMID: 21331638 PMCID: PMC3111554 DOI: 10.1007/s10802-011-9493-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The aim of the present study was to investigate the effect of both tic disorder (TD) and attention-deficit/hyperactivity disorder (ADHD) on attentional functions. N=96 children and adolescents participated in the study, including n=21 subjects with TD, n=23 subjects with ADHD, n=25 subjects with TD+ADHD, and n=27 controls. Attentional performance was tested based on four computerized attention tasks (sustained attention, divided attention, go/nogo and set shifting). The effect of TD as well as ADHD on attentional performance was tested using a 2 × 2 factorial approach. A diagnosis of TD had no negative impact on attentional functions but was associated with improved performance in the set shifting task. By contrast, regardless of a diagnosis of TD, subjects with ADHD were found to perform worse in the sustained attention, divided attention and go/nogo task. No interaction effect between the factors TD and ADHD was revealed for any of the attention measures. Our results add to findings from other areas of research, showing that in subjects with TD and ADHD, ADHD psychopathology is often the main source of impairment, whereas a diagnosis of TD has little or no impact on neuropsychological performance in most cases and even seems to be associated with adaptive mechanisms.
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Affiliation(s)
- Ellen Greimel
- Child Neuropsychology Section, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital of RWTH Aachen, 52074, Aachen, Germany.
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29
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Roessner V, Plessen KJ, Rothenberger A, Ludolph AG, Rizzo R, Skov L, Strand G, Stern JS, Termine C, Hoekstra PJ. European clinical guidelines for Tourette syndrome and other tic disorders. Part II: pharmacological treatment. Eur Child Adolesc Psychiatry 2011; 20:173-96. [PMID: 21445724 PMCID: PMC3065650 DOI: 10.1007/s00787-011-0163-7] [Citation(s) in RCA: 275] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
To develop a European guideline on pharmacologic treatment of Tourette syndrome (TS) the available literature was thoroughly screened and extensively discussed by a working group of the European Society for the Study of Tourette syndrome (ESSTS). Although there are many more studies on pharmacotherapy of TS than on behavioral treatment options, only a limited number of studies meets rigorous quality criteria. Therefore, we have devised a two-stage approach. First, we present the highest level of evidence by reporting the findings of existing Cochrane reviews in this field. Subsequently, we provide the first comprehensive overview of all reports on pharmacological treatment options for TS through a MEDLINE, PubMed, and EMBASE search for all studies that document the effect of pharmacological treatment of TS and other tic disorders between 1970 and November 2010. We present a summary of the current consensus on pharmacological treatment options for TS in Europe to guide the clinician in daily practice. This summary is, however, rather a status quo of a clinically helpful but merely low evidence guideline, mainly driven by expert experience and opinion, since rigorous experimental studies are scarce.
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Affiliation(s)
- Veit Roessner
- Department of Child and Adolescent Psychiatry, University of Dresden Medical School, Fetscherstrasse 74, 01307 Dresden, Germany.
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30
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Cath DC, Hedderly T, Ludolph AG, Stern JS, Murphy T, Hartmann A, Czernecki V, Robertson MM, Martino D, Munchau A, Rizzo R. European clinical guidelines for Tourette syndrome and other tic disorders. Part I: assessment. Eur Child Adolesc Psychiatry 2011; 20:155-71. [PMID: 21445723 PMCID: PMC3065640 DOI: 10.1007/s00787-011-0164-6] [Citation(s) in RCA: 128] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
A working group of the European Society for the Study of Tourette Syndrome (ESSTS) has developed the first European assessment guidelines of Tourette Syndrome (TS). The available literature including national guidelines was thoroughly screened and extensively discussed in the expert group of ESSTS members. Detailed clinical assessment guidelines of tic disorders and their comorbidities in both children and adults are presented. Screening methods that might be helpful and necessary for specialists' differential diagnosis process are suggested in order to further analyse cognitive abilities, emotional functions and motor skills. Besides clinical interviews and physical examination, additional specific tools (questionnaires, checklists and neuropsychological tests) are recommended.
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Affiliation(s)
- Danielle C Cath
- Department of Clinical and Health Psychology, Utrecht University/Altrecht Academic Anxiety Outpatient Services, PO Box 80.140, 3508 TC Utrecht, The Netherlands.
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31
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Roessner V, Wittfoth M, Schmidt-Samoa C, Rothenberger A, Dechent P, Baudewig J. Altered motor network recruitment during finger tapping in boys with Tourette syndrome. Hum Brain Mapp 2011; 33:666-75. [PMID: 21391282 DOI: 10.1002/hbm.21240] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2010] [Revised: 11/09/2010] [Accepted: 11/29/2010] [Indexed: 01/18/2023] Open
Abstract
In Tourette syndrome (TS), not only the tics but also the findings on deficits in motor performance indicate motor system alterations. But our knowledge about the pathophysiology of the motor system in TS is still limited. To better understand the neuronal correlates of motor performance in TS, 19 treatment-naïve boys [age 12.5 (SD 1.4) years] with TS without comorbid symptomatology were compared to an age-matched healthy control group [n = 16; age 12.9 (SD 1.6) years] in regard to brain activation during right-hand index finger tapping by means of functional magnetic resonance imaging. Group differences were found mainly in the left (contralateral) precentral gyrus, which was less activated in boys suffering from TS and in caudate nucleus as well as in medial prefrontal cortex, which was more activated compared to healthy boys. These results show that even in the first years after the onset of the disorder, an altered brain network of motor performance is recruited. These alterations in brain regions frequently associated with TS are probably based on functional changes, which are discussed in terms of early compensatory mechanisms of the motor execution network.
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Affiliation(s)
- Veit Roessner
- Department of Child and Adolescent Psychiatry, University Clinic Carl Gustav Carus, Dresden, Germany.
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32
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Roessner V, Overlack S, Schmidt-Samoa C, Baudewig J, Dechent P, Rothenberger A, Helms G. Increased putamen and callosal motor subregion in treatment-naïve boys with Tourette syndrome indicates changes in the bihemispheric motor network. J Child Psychol Psychiatry 2011; 52:306-14. [PMID: 20883521 DOI: 10.1111/j.1469-7610.2010.02324.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Despite an increasing number of studies, findings of structural brain alterations in patients with Tourette syndrome are still inconsistent. Several confounders (comorbid conditions, medication, gender, age, IQ) might explain these discrepancies. In the present study, these confounders were excluded to identify differences in basal ganglia and corpus callosum size that can be ascribed more probably to Tourette syndrome per se. METHODS High-resolution T1-weighted structural magnetic resonance images of 49 boys with Tourette syndrome were compared with those of 42 healthy boys. The groups were matched for IQ and age (9 to 15 years). Boys with comorbid conditions and previous treatment were excluded. Volumes of gray and white matter, cerebrospinal fluid as well as the size of the basal ganglia, the thalamus, the corpus callosum and its subregions were estimated. RESULTS The left and right putamen and subregion 3 of the corpus callosum were larger in boys with Tourette syndrome than in healthy controls. No differences were found in volumes of caudate nucleus, globus pallidus or thalamus of each hemisphere or in total callosal size and its other subregions. CONCLUSIONS Bilateral enlargement of the putamen may reflect dopaminergic dysfunction or neuroimmunologic alterations (PANDAS) underlying Tourette syndrome. The larger callosal motor subregion 3 might be a consequence of daily tic activity. Previous divergent volumetric findings might be ascribed to confounding variables like comorbid conditions or medication, or to different imaging methods.
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Affiliation(s)
- Veit Roessner
- Department of Child and Adolescent Psychiatry, University Medical Centre, Dresden, Germany.
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33
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Graham J, Banaschewski T, Buitelaar J, Coghill D, Danckaerts M, Dittmann RW, Döpfner M, Hamilton R, Hollis C, Holtmann M, Hulpke-Wette M, Lecendreux M, Rosenthal E, Rothenberger A, Santosh P, Sergeant J, Simonoff E, Sonuga-Barke E, Wong ICK, Zuddas A, Steinhausen HC, Taylor E. European guidelines on managing adverse effects of medication for ADHD. Eur Child Adolesc Psychiatry 2011; 20:17-37. [PMID: 21042924 PMCID: PMC3012210 DOI: 10.1007/s00787-010-0140-6] [Citation(s) in RCA: 227] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2010] [Accepted: 10/06/2010] [Indexed: 01/08/2023]
Abstract
The safety of ADHD medications is not fully known. Concerns have arisen about both a lack of contemporary-standard information about medications first licensed several decades ago, and signals of possible harm arising from more recently developed medications. These relate to both relatively minor adverse effects and extremely serious issues such as sudden cardiac death and suicidality. A guidelines group of the European Network for Hyperkinetic Disorders (EUNETHYDIS) has therefore reviewed the literature, recruited renowned clinical subspecialists and consulted as a group to examine these concerns. Some of the effects examined appeared to be minimal in impact or difficult to distinguish from risk to untreated populations. However, several areas require further study to allow a more precise understanding of these risks.
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Affiliation(s)
- J. Graham
- Child and Adolescent Psychiatry, The Centre for Child Health, Dundee, UK
| | - T. Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, J 5, Mannheim, Germany ,Department of Child and Adolescent Psychiatry, University of Göttingen, Göttingen, Germany
| | - J. Buitelaar
- Karakter Child and Adolescent Psychiatry University Center Nijmegen, Nijmegen, The Netherlands
| | - D. Coghill
- Centre for Neuroscience, University of Dundee, Dundee, Scotland, UK
| | - M. Danckaerts
- Department Child and Adolescent Psychiatry, UZ Gasthuisberg, Leuven, Belgium
| | - R. W. Dittmann
- Psychosomatic Department, Children’s Hospital, University of Hamburg, Hamburg, Germany
| | - M. Döpfner
- Psychiatry and Psychotherapy of Childhood and Adolescence, University of Cologne, Cologne, Germany
| | - R. Hamilton
- The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - C. Hollis
- Section of Developmental Psychiatry, Division of Psychiatry, University of Nottingham, Nottingham, UK
| | - M. Holtmann
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, J 5, Mannheim, Germany
| | - M. Hulpke-Wette
- Pediatric Cardiology, University of Göttingen, Göttingen, Germany
| | - M. Lecendreux
- Child and Adolescent Psychopathology Unit, Robert Debre Hospital, Paris VII University, Paris, France
| | - E. Rosenthal
- Evelina Children’s Hospital, St Thomas’ Hospital, London, UK
| | - A. Rothenberger
- Department of Child and Adolescent Psychiatry, University of Göttingen, Göttingen, Germany
| | - P. Santosh
- Department of Psychological Medicine, Hospital for Children, Great Ormond Street, London, UK
| | - J. Sergeant
- Department of Clinical Neuropsychology, Faculty of Psychology and Education, Vrije Universiteit, Amsterdam, The Netherlands
| | - E. Simonoff
- Social, Developmental and Psychiatry Research Centre, Institute of Psychiatry, London, UK
| | - E. Sonuga-Barke
- School of Psychology, University of Southampton, Southampton, UK ,Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - I. C. K. Wong
- University of London and Institute of Child Health, University College London, London, UK
| | - A. Zuddas
- Child Neuropsychiatry, Department of Neuroscience, University of Cagliari, Cagliari, Italy
| | - H.-C. Steinhausen
- Department of Child and Adolescent Psychiatry, University of Zürich, Zürich, Switzerland
| | - E. Taylor
- MRC Social Genetic Developmental and Psychiatry Centre, Institute of Psychiatry, London, UK
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Roessner V, Hoekstra PJ, Rothenberger A. Tourette's disorder and other tic disorders in DSM-5: a comment. Eur Child Adolesc Psychiatry 2011; 20:71-4. [PMID: 21076848 PMCID: PMC3038221 DOI: 10.1007/s00787-010-0143-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2010] [Accepted: 10/23/2010] [Indexed: 11/29/2022]
Abstract
Classification of tic disorders will be revised in the forthcoming edition of the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5). We do not support the suggestion to move tic disorders to "Anxiety and Obsessive-Compulsive Disorders", if the section "Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence" is not retained. Other than that, most proposed changes of the criteria for tic disorders contain a number of welcome improvements, e.g., the more unified definition of tics including the removal of the term "stereotyped" and the better capture of the temporal pattern of tics (e.g., removal of the maximum 3 months criterion for a tic-free period in chronic tic disorders). But, unfortunately there are some inconsistencies in detail, e.g., the unification of diagnostic criteria for tic disorders had not been consistently pursued in transient tic disorder. In sum, the proposed DSM-5 criteria could be seen as an important step forward particularly in clinical routine. However, continued research is needed to justify the existing and proposed classification of tic disorders as well as to better clarify what other changes should be made in the DSM-5 and beyond.
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Affiliation(s)
- Veit Roessner
- Department of Child and Adolescent Psychiatry, University of Dresden, Goetheallee 12, 01309 Dresden, Germany.
| | - Pieter J. Hoekstra
- Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Aribert Rothenberger
- Department of Child and Adolescent Psychiatry, University of Göttingen, Von-Siebold-Straße 5, 37075 Göttingen, Germany
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35
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More objective tools should be employed to objectify the therapeutic response. J Dev Behav Pediatr 2010; 31:733. [PMID: 21057259 DOI: 10.1097/dbp.0b013e3181fb3337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Frölich J, Starck M, Banaschewski T, Lehmkuhl G. [Aripiprazole - a medical treatment alternative for Tourette Syndrome in childhood and adolescence]. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2010; 38:291-8. [PMID: 20617499 DOI: 10.1024/1422-4917/a000049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE We report a case-series of seven patients with a medical history of at least two years of tic disorder treated with the partial dopamine agonist aripiprazole to illustrate its efficacy as a treatment alternative for motor and vocal tics in children and adolescents. METHOD A case series of five patients with Tourette Syndrome (TS) and two with chronic motor tic disorder (age range 8; 7-18; 1 year), the majority of whom had been refractory to treatment with other neuroleptics or had ceased treatment due to intolerable side effects, were treated for eight weeks with aripiprazole. Before and after treatment, parents rated the severity of motor and vocal tic symptoms on the Yale Tourette Syndrome Checklist. RESULTS Within eight weeks mean motor tic symptoms decreased by 66% and mean vocal tic symptoms decreased by 26%. Mean effective dosage was 14.3 mg/day (min. 5 mg, max. 30 mg). Symptoms of comorbid ADHD or Obsessive Compulsive Disorder were not significantly influenced. During medication only mild side effects were observed, e.g., abdominal pain, fatigue and increased emotional sensitivity. No patient dropped out of treatment due to side effects. CONCLUSIONS Aripiprazole may be an effective pharmacologic treatment alternative for individuals with chronic motor tic disorder and TS. It induces quick, significant and sustained effects with few generally mild and transient side effects, if anything. Its effectiveness, especially relative to comorbidities, should be verified in double-blind, placebo-controlled studies.
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Affiliation(s)
- Jan Frölich
- Klinik und Poliklinik für Psychiatrie und, Psychotherapie des Kindes- und Jugendalters, Zentralinstitut für Seelische Gesundheit, J 5, DE - 68072 Mannheim.
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Schlander M, Schwarz O, Rothenberger A, Roessner V. Tic disorders: administrative prevalence and co-occurrence with attention-deficit/hyperactivity disorder in a German community sample. Eur Psychiatry 2010; 26:370-4. [PMID: 20427154 DOI: 10.1016/j.eurpsy.2009.10.003] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2009] [Revised: 10/12/2009] [Accepted: 10/18/2009] [Indexed: 11/30/2022] Open
Abstract
Coexistence of tics and attention-deficit/hyperactivity disorder (ADHD) has important clinical and scientific implications. Existing data on the co-occurrence of tic disorders, Tourette Syndrome (TS), and ADHD are largely derived from small-scale studies in selected samples and therefore heterogeneous. The Nordbaden project captures the complete outpatient claims data of more than 2.2 million persons, representing 82% of the regional population in 2003. Based upon the number of diagnosed cases of tic disorders, TS, and ADHD, we determined 12-months administrative prevalence rates as well as rates of co-occurrence. Both tic disorders and ADHD were diagnosed most often in the age group 7-12 years (any tic disorder: 0.8%; ADHD: 5.0%). With increasing age, the administrative prevalence difference in favor of males disappeared, with tic disorders being somewhat more frequently reported in females than males in the age groups above 30 years. The highest rate of ADHD co-occurring with tic disorders was found in adolescents (age 13-18 years, 15.1%). Tic disorders were observed in 2.3% of patients with ADHD. Administrative prevalence rates of tic disorders and TS were substantially lower compared to rates found in community-based epidemiological studies, suggesting that a large number of cases remain undetected and untreated under present conditions of routine outpatient care.
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Affiliation(s)
- M Schlander
- Institute for Innovation & Valuation in Health Care (InnoVal(HC)), An der Ringkirche 4, 65197 Wiesbaden, Germany.
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Roessner V, Overlack S, Baudewig J, Dechent P, Rothenberger A, Helms G. No brain structure abnormalities in boys with Tourette's syndrome: a voxel-based morphometry study. Mov Disord 2010; 24:2398-403. [PMID: 19890999 DOI: 10.1002/mds.22847] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Morphometric findings in Tourette's syndrome (TS) are still inconsistent probably due to differences in analysis approaches as well as several confounders (coexisting psychiatric conditions, medication status, etc.). Our aim was to identify possible morphometric changes in a well-defined sample of drug-naïve boys with "pure" TS. High-resolution structural magnetic resonance images of 38 boys with TS were compared with those of 38 healthy boys matched for age and IQ using voxel-based morphometry (VBM). Coexisting psychiatric conditions and previous medication were excluded. The inclusion of 10- to 15-year-old boys minimized the well known compensatory changes due to tic suppression over many years. VBM analyses revealed no differences between the treatment naïve boys with "pure" TS and healthy controls. Brain morphology is not altered in boys with "pure" TS. Further studies should reveal whether previous findings might be ascribed to confounding factors like coexisting psychiatric conditions or long-term compensatory mechanisms due to voluntary tic suppression.
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Affiliation(s)
- Veit Roessner
- Department of Child and Adolescent Psychiatry, University Medical Center, University of Dresden, Dresden, Germany.
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Sawyer ACP, Clark CR, Keage HAD, Moores KA, Clarke S, Kohn MR, Gordon E. Cognitive and electroencephalographic disturbances in children with attention-deficit/hyperactivity disorder and sleep problems: new insights. Psychiatry Res 2009; 170:183-91. [PMID: 19854519 DOI: 10.1016/j.psychres.2008.10.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2008] [Revised: 08/27/2008] [Accepted: 10/23/2008] [Indexed: 11/24/2022]
Abstract
There is overlap between the behavioural symptoms and disturbances associated with Attention-Deficit/Hyperactivity Disorder (AD/HD) and sleep problems. The aim of this study was to examine the extent of overlap in cognitive and electrophysiological disturbances identified in children experiencing sleep problems and children with AD/HD or both. Four groups (aged 7-18) were compared: children with combined AD/HD and sleep problems (n=32), children with AD/HD (n=52) or sleep problems (n=36) only, and children with neither disorder (n=119). Electrophysiological and cognitive function measures included: absolute EEG power during eyes open and eyes closed, event-related potential (ERP) components indexing attention and working memory processes (P3), and a number of standard neuropsychological tests. Children with symptoms of both AD/HD and sleep problems had a different profile from those of children with either AD/HD or sleep problems only. These findings suggest it is unlikely that disturbances in brain and cognitive functioning associated with sleep problems also give rise to AD/HD symptomatology and consequent diagnosis. Furthermore, findings suggest that children with symptoms of both AD/HD and sleep problems may have a different underlying aetiology than children with AD/HD-only or sleep problems-only, perhaps requiring unique treatment interventions.
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Bechtel N, Kobel M, Penner IK, Klarhöfer M, Scheffler K, Opwis K, Weber P. Decreased fractional anisotropy in the middle cerebellar peduncle in children with epilepsy and/or attention deficit/hyperactivity disorder: a preliminary study. Epilepsy Behav 2009; 15:294-8. [PMID: 19362604 DOI: 10.1016/j.yebeh.2009.04.005] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2009] [Revised: 04/02/2009] [Accepted: 04/04/2009] [Indexed: 12/22/2022]
Abstract
Children with epilepsy are at increased risk for attention deficit/hyperactivity disorder (ADHD). It has been shown that the cerebellum plays a major role in the pathophysiology of ADHD. We aimed to clarify whether children with combined epilepsy/ADHD have the same neurocerebellar pathophysiology as children with developmental ADHD. Eight boys with combined epilepsy/ADHD, 14 boys with developmental ADHD, and 12 healthy boys were investigated using diffusion tensor imaging generating fractional anisotropy (FA) maps. Healthy controls exhibited more FA in the left and in the right middle cerebellar peduncle compared with children with combined epilepsy/ADHD, and more FA in the right middle cerebellar peduncle compared with children with developmental ADHD. Our data show deficient cerebellar connections in both patient groups and endorse the crucial role of the cerebellum in the pathophysiology of ADHD. Our results suggest that ADHD seen in epilepsy might have the same cerebellar pathology as in developmental ADHD.
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Affiliation(s)
- Nina Bechtel
- Department of Cognitive Psychology and Methodology, University of Basel, Basel, Switzerland.
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Roessner V, Albrecht B, Dechent P, Baudewig J, Rothenberger A. Normal response inhibition in boys with Tourette syndrome. Behav Brain Funct 2008; 4:29. [PMID: 18638368 PMCID: PMC2491645 DOI: 10.1186/1744-9081-4-29] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2008] [Accepted: 07/18/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Inhibitory deficits are often a matter of debate in the pathophysiology of Tourette syndrome (TS). Previous neuropsychological studies on behavioral inhibition revealed equivocal results. METHODS To overcome existing shortcomings (e.g. confounders like medication status, comorbid conditions) we compared medication naïve boys (10-14 years) suffering exclusively from TS with age, gender and IQ matched healthy controls using a highly demanding Go/Nogo task that controls for novelty effects. RESULTS The performance did not differ between boys with TS and healthy boys. CONCLUSION In TS normal response inhibition performance as measured by a Go/Nogo task can be assumed. However, there might be neurophysiological abnormalities in TS possibly related to compensatory mechanisms to control for tics. Hence, further studies combining neuropsychological and neurophysiological methods (e.g. electroencephalography, fMRI) using the same strictly controlled design along the whole range of development and tic severity are recommended.
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Affiliation(s)
- Veit Roessner
- Department of Child and Adolescent Psychiatry, University of Goettingen, Germany.
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Tiffin-Richards MC, Hasselhorn M, Woerner W, Rothenberger A, Banaschewski T. Phonological short-term memory and central executive processing in attention-deficit/hyperactivity disorder with/without dyslexia – evidence of cognitive overlap. J Neural Transm (Vienna) 2007; 115:227-34. [PMID: 17906969 DOI: 10.1007/s00702-007-0816-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2007] [Accepted: 08/20/2007] [Indexed: 12/20/2022]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) with/without dyslexia was investigated using a double dissociation design. Neuropsychological performance representing the core deficits of the two disorders was measured in order to test the common deficit hypothesis. Phonological short-term memory, morpho-syntactical language, and central executive processing (manipulating and switching) tasks were administered to four groups of 10-14 year old children (ADHD-only n = 20, dyslexia-only n = 20, ADHD+dyslexia n = 20, and controls n = 19). Comparisons of performance on these tasks were carried out using 2 (ADHD yes/no) x 2 (dyslexia yes/no) factorial analyses of variance and covariance. Significant main effects were found for dyslexia (language processing functions) and for ADHD (EF switching). In the case of the EF manipulating a main effect for both dyslexia and ADHD was revealed. Effect sizes of mean performance indicated that all three impaired groups shared a common deficit in working memory which could reflect a cognitive overlap partly explaining the high rate of co-occurring dyslexia and ADHD.
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Affiliation(s)
- M C Tiffin-Richards
- Department of Child and Adolescent Psychiatry, University of Goettingen, Goettingen, Germany, Goettingen, Germany
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Roessner V, Banaschewski T, Fillmer-Otte A, Becker A, Albrecht B, Uebel H, Sergeant J, Tannock R, Rothenberger A. Color perception deficits in co-existing attention-deficit/hyperactivity disorder and chronic tic disorders. J Neural Transm (Vienna) 2007; 115:235-9. [PMID: 17896072 DOI: 10.1007/s00702-007-0817-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2007] [Accepted: 08/22/2007] [Indexed: 11/27/2022]
Abstract
Preliminary findings suggest that color perception, particularly of blue-yellow stimuli, is impaired in attention-deficit/hyperactivity disorder (ADHD) as well as in chronic tic disorders (CTD). However, these findings have been not replicated and it is unclear what these deficits mean for the comorbidity of ADHD + CTD. Four groups (ADHD, CTD, ADHD + CTD, controls) of children with similar age, IQ and gender distribution were investigated with the Farnsworth-Munsell 100 Hue Test (FMT) and the Stroop-Color-Word Task using a factorial design. Color perception deficits, as indexed by the FMT, were found for both main factors (ADHD and CTD), but there were no interaction effects. A preponderance of deficits on the blue-yellow compared to the red-green axis was detected for ADHD. In the Stroop task only the 'pure' ADHD group showed impairments in interference control and other parameters of Stroop performance. No significant correlations between any FMT parameter and color naming in the Stroop task were found. Basic color perception deficits in both ADHD and CTD could be found. Beyond that, it could be shown that these deficits are additive in the case of comorbidity (ADHD + CTD). Performance deficits on the Stroop task were present only in the 'pure' ADHD group. Hence, the latter may be compensated in the comorbid group by good prefrontal capabilities of CTD. The influence of color perception deficits on Stroop task performance might be negligible.
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Affiliation(s)
- V Roessner
- Department of Child and Adolescent Psychiatry, University of Goettingen, Goettingen, Germany.
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Freeman RD. Tic disorders and ADHD: answers from a world-wide clinical dataset on Tourette syndrome. Eur Child Adolesc Psychiatry 2007; 16 Suppl 1:15-23. [PMID: 17665279 DOI: 10.1007/s00787-007-1003-7] [Citation(s) in RCA: 177] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Tourette syndrome (TS) is a neurodevelopmental disorder with frequent comorbidity with Attention- deficit-Hyperactivity disorder (ADHD). The impact of this association is still a matter of debate. METHOD Using the TIC database containing 6,805 cases, the clinical differences were ascertained between subjects with and without ADHD. RESULTS The reported prevalence of ADHD in TS was 55%, within the range of many other reports. If the proband was diagnosed with ADHD, a family history of ADHD was much more likely. ADHD was associated with earlier diagnosis of TS and a much higher rate of anger control problems, sleep problems, specific learning disability, OCD, Oppositional-defiant disorder, mood disorder, social skill deficits, sexually inappropriate behaviour, and self-injurious behaviour. Subjects with seizures and with Developmental Coordination Disorder also had high rates of ADHD. Anxiety disorder, however, was not more frequent. Preliminary data suggest that most behavioural difficulties in ADHD are associated with the Combined or Hyperactive-Impulsive Subtypes of ADHD. Every large site (>200 cases) had a significantly increased rate of anger control problems in cases with ADHD. CONCLUSION Subjects with TS have high rates of ADHD and complex associations with other disorders. Clinically the findings confirm other research indicating the importance of ADHD in understanding the behavioural problems often associated with the diagnosis of TS. Additional ADHD comorbidity should be taken into account in diagnosis, management, and training.
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Affiliation(s)
- Roger D Freeman
- Neuropsychiatry Clinic, BC Children's Hospital, Box 141, Vancouver, BC, V6H 3V4, Canada.
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Banaschewski T, Neale BM, Rothenberger A, Roessner V. Comorbidity of tic disorders & ADHD: conceptual and methodological considerations. Eur Child Adolesc Psychiatry 2007; 16 Suppl 1:5-14. [PMID: 17665278 DOI: 10.1007/s00787-007-1002-8] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND The causes and pathophysiological mechanisms of the common comorbidity of tic disorders and Attention-deficit/Hyperactivity disorder (TD + ADHD; about 50% of TD, about 20% of ADHD) still remain unclear. Studies with a 2 x 2 design comparing groups of children with TD, ADHD, TD + ADHD and healthy controls are in need and may disentangle the influences of TD versus ADHD in the case of comorbidity. Unfortunately, conceptual and methodological problems can restrain possible conclusions from these studies. METHOD A review of the literature on artifactual and non-artifactual models of comorbidity in general and specially for TD + ADHD was conducted. RESULTS The first section describes various possible models of comorbidity and their corresponding hypotheses concerning expected patterns of findings comparing groups of children with TD, ADHD, TD + ADHD and healthy controls. In the second part research results concerning psychopathological, neuropsychological, neurophysiological, structural and functional imaging, as well as genetic characteristics are summarized. In the third section possible conclusions and their limitations due to conceptual and methodological problems possibly contributing to the ambiguous results are discussed. Finally, future research strategies and the need for full causal models are outlined. CONCLUSION Some components of the etiological pathways of TD + ADHD may well be shared with the 'pure' conditions while others may be unique.
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Affiliation(s)
- Tobias Banaschewski
- Child and Adolescent Psychiatry, University of Goettingen, Goettingen, Germany
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Sukhodolsky DG, Leckman JF, Rothenberger A, Scahill L. The role of abnormal neural oscillations in the pathophysiology of co-occurring Tourette syndrome and attention-deficit/hyperactivity disorder. Eur Child Adolesc Psychiatry 2007; 16 Suppl 1:51-9. [PMID: 17665283 DOI: 10.1007/s00787-007-1007-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To examine the role of aberrant neural oscillatory activity in the pathophysiology of co-occurring Tourette Syndrome (TS) and Attention-Deficit/Hyperactivity Disorder (ADHD). METHOD Neural oscillations refer to periodic variations in the recording of neural activity. The temporal synchronization of oscillations represents a mechanism of neural communication implicated in normal brain functioning as well as psychopathology. We reviewed physiological, imaging, and neuropsychological evidence that tics and symptoms of ADHD may result from abnormal oscillatory activity in the brain. RESULTS Structural and functional abnormalities in the cortical-striatal-thalamo-cortical circuits may result in the disruption of oscillatory activity within the basal ganglia of individuals with TS and lead to transient hyperpolarization of selected thalamocortical regions. Extended to TS plus ADHD this or similar mechanisms, in turn, would lead to the dysrhythmia of particular vulnerable cortical regions and give rise to various deficits in motor control (TS + ADHD) as well as impulsivity and attention (ADHD). Compensatory systems within the prefrontal cortex could be activated and trained to modulate the misguided striatal and thalamocortical oscillations. CONCLUSIONS Although it is highly likely that abnormal neural oscillations have a prominent role in co-occurrence of TS + ADHD, its final relevance in this case deserves further differentiated research (i.e. oscillatory networks disentangled from other neuropsychiatric disorders).
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Affiliation(s)
- Denis G Sukhodolsky
- Child Study Center, Yale University School of Medicine, 230 South Frontage Road, New Haven, CT, 06520, USA.
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Abstract
OBJECTIVES To give an overview concerning the behavioral treatment approaches for Chronic Tic Disorder (CTD) and Attention-Deficit/Hyperactivity Disorder (ADHD) and to provide some suggestions for the behavioral treatment of children and adolescents with a combination of both disorders. RESULTS Pharmacotherapy plays an important role in the treatment of both ADHD and CTD. However, behavior therapy has also been proven to ameliorate the core symptoms of both disorders. The most prominent behavioral technique to reduce tics is habit reversal training. In ADHD behavioral interventions, especially parent training and behavioral interventions in preschool/school, are effective in reducing ADHD core symptoms and comorbid problems. In children and adolescents with ADHD plus CTD both ADHD and tic symptoms can be treated by behavioral interventions alone or in combination with pharmacotherapy. However, most of the published studies on behavioral interventions in children with ADHD or CTD do not give detailed information on comorbidity and many studies excluded patients with comorbid problems. CONCLUSIONS Clinical experience suggests that in CTD+ADHD success may be easier to achieve using behavioral treatment of ADHD first. Adherence to the habit reversal procedure to reduce tics in daily living is the most important problem in the behavioral treatment of tics especially in children with comorbid ADHD. Practical suggestions to overcome these difficulties are presented.
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Affiliation(s)
- Manfred Döpfner
- Department for Child and Adolescent Psychiatry and Psychotherapy, University of Cologne, Robert Koch Str. 10, 50931, Koeln, Germany.
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Roessner V, Becker A, Banaschewski T, Rothenberger A. Executive functions in children with chronic tic disorders with/without ADHD: new insights. Eur Child Adolesc Psychiatry 2007; 16 Suppl 1:36-44. [PMID: 17665281 DOI: 10.1007/s00787-007-1005-5] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE In Chronic Tic Disorders (CTD) associated Attention Deficit Hyperactivity Disorder (ADHD) is very common. Hence, it is important to clarify how both conditions are related to cognitive dysfunctions in patients with CTD+ADHD comorbidity. Recent studies on neuropsychology revealed equivocal results, mostly due to methodological shortcomings like problems in sample composition. Thus better and more detailed information on this topic is needed to improve diagnostic and treatment approaches. METHOD Three tasks related to different domains of executive functions (the Matching Familiar Figures Test, the Stroop color-word interference task, and a computerized version of the Wisconsin Card Sorting Test) have been performed in two independent samples (altogether n = 138 children) both including four groups of children (CTD-only, CTD+ADHD, ADHD-only, healthy controls) matched for age and IQ. To specify the influence of either tics or ADHD-symptoms on executive functions and to answer the question of their interactive or additive relationship two-way analyses of variance (MANOVA) for the factors CTD (yes,-no) x ADHD (yes,no) were conducted. Eta squared was calculated to reveal the effect sizes for each factor. For a deeper understanding of group differences and to better enable the comparison with data in literature, additional analyses of variance (ANOVA) with posthoc testing were applied. RESULTS In summary, there was a main effect only for the factor ADHD reflected by decreased performance, while no main effect of the factor CTD could be found. Admittedly, the effects were not uniform in both samples. However, in all three tasks and both samples, uniformly no interaction between the main factors has been observed. CONCLUSIONS In cases of coexisting CTD+ADHD the factor ADHD shows the main negative impact on neuropsychological performance and this impact seems to be independent of any feature of the coexisting tics (additive model). This supports the notion to primarily treat the ADHD-symptoms in order to increase cognitive self regulatory abilities of these children. Contrarily, tics seem to have little impact on cognitive performance in most cases.
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Affiliation(s)
- Veit Roessner
- Dept. of Child and Adolescent Psychiatry/Psychotherapy, University of Goettingen, Von Siebold-Str. 5, 37075, Goettingen, Germany.
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Roessner V, Becker A, Banaschewski T, Freeman RD, Rothenberger A. Developmental psychopathology of children and adolescents with Tourette syndrome--impact of ADHD. Eur Child Adolesc Psychiatry 2007; 16 Suppl 1:24-35. [PMID: 17665280 DOI: 10.1007/s00787-007-1004-6] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND In Tourette syndrome (TS) as a neurodevelopmental disorder not only the tics but also the comorbid conditions change with increasing age. ADHD is highly comorbid with TS and usually impairs psychosocial functioning more than the tics. Its impact on further comorbidity during development is important for clinical practice and still a matter of debate. METHOD Aspects of developmental psychopathology considering the impact of ADHD were examined by logistic regression (year wisely) in a cross-sectional sample of children and adolescents (n = 5060) from the TIC database. RESULTS In TS+ADHD (compared to TS-ADHD) higher rates of comorbid conditions like OCD, anxiety disorders, CD/ODD and mood disorders were found in children (5-10 years). In adolescents (11-17 years) higher comorbidity rates in TS+ADHD remained only for CD/ODD and mood disorders. Accordingly, for OCD and anxiety disorders there was a steeper year wise increase of these comorbidities in TS-ADHD while it was a similar for CD/ODD and mood disorders in TS-ADHD as well as TS+ADHD. CONCLUSION Children with TS+ADHD have more comorbidities than the TS-ADHD group, whereas in both adolescent groups this did no longer hold for OCD and anxiety disorders. These findings indicate that in TS comorbid ADHD is associated with high rates of externalizing and internalizing problems, whereas TS without ADHD is associated only with internalizing problems in adolescence.
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Affiliation(s)
- Veit Roessner
- Dept. of Child and Adolescent Psychiatry/Psychotherapy, University of Goettingen, Von-Siebold-Str. 5, 37075, Göttingen, Germany.
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Roessner V, Becker A, Banaschewski T, Rothenberger A. Psychopathological profile in children with chronic tic disorder and co-existing ADHD: additive effects. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2006; 35:79-85. [PMID: 17171537 DOI: 10.1007/s10802-006-9086-z] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2005] [Accepted: 11/14/2006] [Indexed: 11/30/2022]
Abstract
The nature of the co-occurrence of chronic tic disorders (CTD) and attention deficit hyperactivity disorder (ADHD) is unclear. Especially in the field of psychopathology, the relationship of CTD and ADHD remains to be clarified. Thus, the aim of the present chart review study was to specify the contribution of CTD and/or ADHD to the psychopathological profile of the comorbid group (CTD+ADHD). The psychopathological profiles of four large groups (CTD-only (n=112), CTD+ADHD (n=82), ADHD-only (n=129), controls (n=144)) were measured by the eight subscales of the Child Behavior Checklist (CBCL) and analyzed by a 2x2 factorial design followed by contrasts. There were main effects of ADHD diagnosis on all but one subscale of the CBCL (Somatic Complaints). For CTD diagnosis, main effects were found for Attention Problems, Anxious/Depressed, Thought Problems, Social Problems and Somatic Complaints. The only interaction effect was seen for Somatic Complaints. While CTD and ADHD were both related to internalizing psychopathology of children in the CTD+ADHD group, ADHD had the largest effect on externalizing psychopathology in the comorbid group. At the level of psychopathology, an additive model for the co-occurrence of CTD and ADHD is strongly supported. In the comorbid group (CTD+ADHD), the ADHD diagnosis shows the strongest relation to externalizing psychopathology.
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Affiliation(s)
- Veit Roessner
- Department of Child and Adolescent Psychiatry, University of Goettingen, Germany, Von--Siebold--Strasse 5, 37075 Goettingen, Germany.
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