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Morgan B, Weisleder P, Patel AD, Parker W, Rose M, Butz C. Screening for Quality of Life in a Neurology Tic Clinic Using Quality Improvement Methodology. Pediatr Neurol 2024; 155:44-50. [PMID: 38583256 DOI: 10.1016/j.pediatrneurol.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 01/30/2024] [Accepted: 02/10/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND Tic disorders in children often co-occur with other disorders that can significantly impact functioning. Screening for quality of life (QoL) can help identify optimal treatment paths. This quality improvement (QI) study describes implementation of a QoL measure in a busy neurology clinic to help guide psychological intervention for patients with tics. METHODS Using QI methodology outlined by the Institute for Healthcare Improvement, this study implemented the PedsQL Generic Core (4.0) in an outpatient medical clinic specializing in the diagnosis and treatment of tic disorders. Assembling a research team to design process maps and key driver diagrams helped identify gaps in the screening process. Conducting several plan-do-study-act cycles refined identification of patients appropriate to receive the measure. Over the three-year study, electronic health record notification tools and data collection were increasingly utilized to capture patients' information during their visit. RESULTS Over 350 unique patients were screened during the assessment period. Electronic means replaced paper measures as time progressed. The percentage of patients completing the measure increased from 0% to 51.9% after the initial implementation of process improvement, advancing to 91.6% after the introduction of electronic measures. This average completion rate was sustained for 15 months. CONCLUSIONS Using QI methodology helped identify the pragmatics of implementing a QoL assessment to enhance screening practices in a busy medical clinic. Assessment review at the time of appointment helped inform treatment and referral decisions.
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Affiliation(s)
- Brandon Morgan
- Department of Psychology and Neuropsychology, Nationwide Children's Hospital, Columbus, Ohio.
| | - Pedro Weisleder
- Division of Child Neurology, Nationwide Children's Hospital, Columbus, Ohio; Department of Pediatrics, The Ohio State University, Columbus, Ohio
| | - Anup D Patel
- Division of Child Neurology, Nationwide Children's Hospital, Columbus, Ohio; Department of Pediatrics, The Ohio State University, Columbus, Ohio; The Center for Clinical Excellence, Nationwide Children's Hospital, Columbus, Ohio
| | - William Parker
- Division of Child Neurology, Nationwide Children's Hospital, Columbus, Ohio; The Center for Clinical Excellence, Nationwide Children's Hospital, Columbus, Ohio
| | - Megan Rose
- Division of Child Neurology, Nationwide Children's Hospital, Columbus, Ohio; The Center for Clinical Excellence, Nationwide Children's Hospital, Columbus, Ohio
| | - Catherine Butz
- Department of Psychology and Neuropsychology, Nationwide Children's Hospital, Columbus, Ohio; Department of Pediatrics, The Ohio State University, Columbus, Ohio
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Heijerman-Holtgrefe AP, Huyser C, Bus M, Beljaars LPL, van de Griendt JMTM, Verdellen CWJ, Kan KJ, Zijlstra BJH, Lindauer RJL, Cath DC, Hoekstra PJ, Utens EMWJ. Tackle your Tics, a brief intensive group-based exposure treatment for young people with tics: results of a randomised controlled trial. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02410-0. [PMID: 38575665 DOI: 10.1007/s00787-024-02410-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 03/01/2024] [Indexed: 04/06/2024]
Abstract
Tics can have a serious impact on the quality of life of children and their families. Behavioural therapy is an evidence-based first line treatment for tic disorders. This randomised controlled trial studied the efficacy of a brief, condensed group-based programme for children with tics (Dutch Trial Registry NL8052, 27 September 2019). Tackle your Tics is a four-day group treatment, including exposure and response prevention and supporting components, delivered by therapists and 'experts by experience'. We collected outcome measures at baseline (T1), directly post-treatment (T2), and at three- and 6-months follow-up (T3, T4) including tic severity (primary outcome measure), tic-related impairment, quality of life, tic-related cognitions, emotional/behavioural functioning, family functioning, treatment satisfaction and adherence. Outcomes directly post-treatment improved in both the treatment group (n = 52) and waiting list (n = 54), but showed no statistically significant differences between the conditions (differential change over time T1-T2) on tic severity (Yale Global Tic Severity Scale), quality of life (Gilles de la Tourette Syndrome Quality of Life Scale), tic-related cognitions and family functioning. At longer term (T3), again no between-group difference was found on tic severity, but tic-related impairment, quality of life and emotional/behavioural functioning significantly improved in the treatment group compared to the waiting list. Mean treatment satisfaction scores were favourable for both children and parents. Directly posttreatment, Tackle your Tics showed no superior effect compared to waiting list. However, on longer term this brief four-day group treatment was effective in improving tic-related impairment, quality of life and emotional/behavioural functioning.
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Affiliation(s)
- A P Heijerman-Holtgrefe
- Academic Center for Child and Adolescent Psychiatry, Levvel, Amsterdam, The Netherlands
- Department of Child and Adolescent Psychiatry, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Dutch Tourette Association, Haarlem, The Netherlands
| | - C Huyser
- Academic Center for Child and Adolescent Psychiatry, Levvel, Amsterdam, The Netherlands
| | - M Bus
- Academic Center for Child and Adolescent Psychiatry, Levvel, Amsterdam, The Netherlands
| | - L P L Beljaars
- Academic Center for Child and Adolescent Psychiatry, Levvel, Amsterdam, The Netherlands
- Dutch Tourette Association, Haarlem, The Netherlands
- Expertisecentrum Valora, Veldhoven, The Netherlands
| | | | - C W J Verdellen
- TicXperts, Heteren, The Netherlands
- PsyQ Nijmegen/Parnassia Group, Nijmegen, The Netherlands
| | - K J Kan
- Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands
| | - B J H Zijlstra
- Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands
| | - R J L Lindauer
- Academic Center for Child and Adolescent Psychiatry, Levvel, Amsterdam, The Netherlands
- Department of Child and Adolescent Psychiatry, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - D C Cath
- Department of Specialized Training, GGZ Drenthe, Assen, The Netherlands
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - P J Hoekstra
- Department of Child and Adolescent Psychiatry and Accare Child Study Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - E M W J Utens
- Academic Center for Child and Adolescent Psychiatry, Levvel, Amsterdam, The Netherlands.
- Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands.
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands.
- Department of Emotional Disorders, Levvel, Meibergdreef 5, Amsterdam, The Netherlands.
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Pring K, Malli M, Hardy BW, Rapp SR, Storch EA, Mink JW, Martindale JM. Reframing stigma in Tourette syndrome: an updated scoping review. Eur Child Adolesc Psychiatry 2023:10.1007/s00787-023-02332-3. [PMID: 38159134 DOI: 10.1007/s00787-023-02332-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 11/28/2023] [Indexed: 01/03/2024]
Abstract
Persistent tic disorders (PTD) such as Tourette's syndrome (TS) are common childhood-onset neurodevelopmental disorders. Stigmatization of individuals with these disorders remains an ongoing problem. The purpose of this scoping review is to serve as an updated review of the research regarding stigmatization in youth with PTD since the publication of the original systematic review about this topic in 2016. The electronic databases Embase, Web of Science, PubMed, PsycINFO, and CINAHL were searched. Of the 4751 initial articles screened after removing duplications, 47 studies met the inclusion criteria. The studies were examined under the social-ecological stigmatization model, which helps categorize stigmatization into individual, interpersonal, community, and structural levels and serves as a broader definition of stigmatization than the previous systematic review. On the individual level, youth with PTD had lower self-esteem than peers, often leading to fear of future stigmatization, avoidant behaviors, and self-stigmatization. They also experienced higher rates of bullying and other forms of abuse than peers at the interpersonal level. At the community level, youth with PTD faced discriminatory environments in school and work and limited availability of community services and healthcare access. At the structural level, knowledge about PTD was limited in the general population, often about the limited portrayals of PTD in the media. We hope that the broader scope of this review serves to help inform future efforts to decrease the stigmatization faced by this group.
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Affiliation(s)
- Kelly Pring
- Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Melina Malli
- Institute of Population Ageing, University of Oxford, Oxford, UK
| | - Brandy W Hardy
- Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Stephen R Rapp
- Department of Psychology and Behavioral Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Eric A Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | | | - Jaclyn M Martindale
- Department of Neurology, Wake Forest University School of Medicine, North Carolina, Winston-Salem, NC, USA.
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4
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Bekk M, Meland KJ, Moen E, Nøstvik LI, Gausdal AL, Hummelen B. Group-based comprehensive behavioral intervention for tics (CBIT) for adults with Tourette syndrome or chronic tic disorders: A pilot study. Scand J Psychol 2023; 64:784-793. [PMID: 37339108 DOI: 10.1111/sjop.12942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 05/15/2023] [Accepted: 05/29/2023] [Indexed: 06/22/2023]
Abstract
Comprehensive behavioral intervention for tics (CBIT) administered individually is an effective treatment for tics. However, the effectiveness of CBIT administered in groups for adults with Tourette syndrome and chronic tic disorders has not been investigated yet. This pilot study examined the effectiveness of group-based CBIT with respect to reduction of tic severity and tic-related impairment, as well as improvement of tic-related quality of life. Data from 26 patients were included in the intention-to-treat analyses. The Yale Global Tic Severity Scale was used to assess total tic severity and tic-related impairment. The Gilles de la Tourette - Quality of Life Scale was used to assess tic-related quality of life. These measures were administered at three points in time: at pretreatment, posttreatment, and 1-year follow-up. The results showed a significant reduction of total tic severity from pretreatment to 1-year follow-up, with larges effect sizes. Tic-related impairment and tic-related quality of life also improved significantly, although the effect sizes were smaller. Motor tics showed a stronger reduction than vocal tics. Additional analysis revealed that all change was achieved during treatment and that this effect was maintained from posttreatment to 1-year follow-up. The results of this study indicate that group-based CBIT is a promising treatment for tics.
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Affiliation(s)
- Morten Bekk
- Regional Resource Centre for Autism, ADHD and Tourette Syndrome, Health Region South-East, Oslo University Hospital, Oslo, Norway
| | - Karete J Meland
- Outpatient Unit for OCD-Spectrum Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Erna Moen
- Outpatient Unit for OCD-Spectrum Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | | | | | - Benjamin Hummelen
- Department of Research and Innovation, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
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Schütteler C, Woitecki K, Döpfner M, Gerlach AL. Interoception and premonitory urges in children and adolescents with tic disorders. CLINICAL PSYCHOLOGY IN EUROPE 2023; 5:e8185. [PMID: 37065000 PMCID: PMC10103159 DOI: 10.32872/cpe.8185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 10/25/2022] [Indexed: 04/03/2023] Open
Abstract
Background
Compared to healthy controls (HCs), adult Tic Disorder (TD) patients exhibit a lower interoceptive accuracy (IAcc) in heartbeat perception. Since the lower IAcc is not evident in children, the age at which tics develop, but in adults only (Pile et al., 2018, https://doi.org/10.1007/s10803-018-3608-8), lower IAcc may reflect a pathological mechanism relevant with regard to tics, premonitory urges (PUs) or the resulting impairment. Although tics are a motor phenomenon, up to date, IAcc has been assessed only with a heartbeat-counting task. This study aims at comparing cardiac and muscular IAcc using two different paradigms and investigates how IAcc is related to premonitory urges in youth.
Method
Interoceptive measures (heartbeat-counting task, muscle tension paradigm) of 28 youth with TD were compared to 23 control participants and related to self-rated premonitory urges and tic symptoms.
Results
TD patients did not differ from HCs in any IAcc measures. However, within TD patients, IAcc explained additional variance in PUs when controlling for tic severity. Muscular IAcc in TD patients is related to urges and tics, but the direction of this association is unclear. IAcc is lower in TD patients than in HCs, indicating imprecise sensory input which is more easily overcome by priors within the predictive coding framework.
Conclusions
Muscle tension feedback tasks could extend interoceptive trainings aimed at improving IAcc to improve accuracy of urge perception (more precise sensory input) to foster the ability to control tics via HRT. Longitudinal studies could provide further insights in causal relationships between IAcc, premonitory urges and tics.
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Swisher V, Tooker M, Qu C, Burgess HJ, Coles ME, Bennett S, Piacentini J, Colwell CS, Ricketts EJ. Sleep Disorders, Sleep Medication Use, and Predictors of Sleep Disturbance in Children with Persistent Tic Disorders. CHILDRENS HEALTH CARE 2023; 53:23-40. [PMID: 38435344 PMCID: PMC10904019 DOI: 10.1080/02739615.2023.2175682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
The present study examined rates of sleep disorders and sleep medication use, and predictors of sleep disturbance in children with persistent tic disorders (PTD). Sixty-three parents of children aged 10 to 17 years with PTDs completed an internet survey evaluating sleep patterns and clinical symptoms. Insomnia (19.4%), nightmares (16.1%), and bruxism (13.1%) were the most commonly reported lifetime sleep disorders. Fifty-two percent endorsed current sleep medication use. Higher ADHD severity, overall life impairment, and female sex predicted greater sleep disturbance. Findings suggest the utility of clinical management of co-occurring ADHD and impairment to mitigate sleep disturbance in children with PTDs.
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Affiliation(s)
- Valerie Swisher
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
| | - Maya Tooker
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
| | - Christine Qu
- Department of Biological Sciences, Columbia University
| | | | | | - Shannon Bennett
- Department of Psychiatry, Weill Cornell Medicine, New York, NY 10065
| | - John Piacentini
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
| | - Christopher S. Colwell
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
| | - Emily J. Ricketts
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
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7
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Liu F, Wang G, Yao B, Ye J, Wang J, Wang H, Liu H. Cross-sectional investigation of quality of life determinants among children with tic disorders: The roles of family environmental and clinical factors. Heliyon 2023; 9:e13228. [PMID: 36785827 PMCID: PMC9918760 DOI: 10.1016/j.heliyon.2023.e13228] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 01/08/2023] [Accepted: 01/21/2023] [Indexed: 01/26/2023] Open
Abstract
Objective To examine the association between family environmental and clinical factors with the whole range of quality of life (QOL) in children with tic disorders (TD). Methods A hospital-based cross-sectional study was conducted among children with TD. All participants were given a family environmental survey and scale evaluations with Yale Global Tic Severity Scale (YGTSS), Achenbach Child Behavior Checklist (CBCL) and PedsQL-Generic Core Scale of the Chinese Version (PedsQL). Variable selection and data analysis was done by the least absolute shrinkage and selection operator (LASSO) method and multivariate logistic regression analysis. Results A total of 363 TD cases were included in the analysis. YGTSS scores, total CBCL score had significant negative correlations with PedsQL scores (P < 0.05). Of the total 15 factors, 8, 6, 11, 7, 5, 10 potential predictors with nonzero coefficients were identified by LASSO regression models of physical functioning, emotional functioning, social functioning, school functioning, social-psychological domain and PedsQL total scale respectively. Results of multivariate logistic regression analysis showed older age (physical functioning, ORs: 1.77, 3.67; total scale: ORs: 1.73, 2.28), no presence of chronic conditions (school functioning, OR: 1.61), moderate/severe tic severity (physical functioning, OR: 0.57; social functioning, OR: 0.44; social-psychological domain, OR: 0.57), co-morbid behavioral problems (physical functioning, OR: 0.52; emotional functioning, OR: 0.31; social functioning, OR: 0.30; school functioning, OR: 0.35; social-psychological domain, OR: 0.34; total scale, OR: 0.30), no fully parental involvement in care (physical functioning, OR: 0.62), higher paternal (physical functioning, ORs: 2.89, 2.07) and maternal education level (social functioning, ORs: 1.74, 2.03), democratic parenting pattern (emotional functioning, OR: 1.89; social functioning, OR: 2.17; social-psychological domain, OR: 2.33; total scale, OR: 2.11) and inharmony family relationship (emotional functioning, OR: 0.47; total scale, OR: 0.50) were the most important determinants to QOL of TD. Conclusions This study identifies several QOL determinants among children with TD. Clinicians should be encouraged to screen for family environmental and clinical factors in TD patients, and take tailored interventions to help TD children improve their QOL.
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Affiliation(s)
- Fang Liu
- Department of Pediatrics, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Gaohua Wang
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, 430060, China,Corresponding author.
| | - Baozhen Yao
- Department of Pediatrics, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Jingping Ye
- Department of Pediatrics, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Junling Wang
- Department of Pediatrics, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Huaqian Wang
- Department of Pediatrics, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Hong Liu
- Department of Pediatrics, Renmin Hospital of Wuhan University, Wuhan, 430060, China
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Greenberg E, Albright C, Hall M, Hoeppner S, Miller S, Farley A, Silverman M, Braddick V, Sprich S, Wilhelm S. Modified Comprehensive Behavioral Intervention for Tics: Treating Children With Tic Disorders, Co-Occurring ADHD, and Psychosocial Impairment. Behav Ther 2023; 54:51-64. [PMID: 36608977 DOI: 10.1016/j.beth.2022.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 07/07/2022] [Accepted: 07/10/2022] [Indexed: 01/11/2023]
Abstract
Our objective was to evaluate the feasibility and acceptability, and preliminary efficacy of a modified comprehensive behavioral intervention for tics (MCBIT) therapy for youth with chronic tic disorders (CTDs), co-occurring attention-deficit hyperactivity disorder (ADHD), and associated psychosocial impairment. Seventeen youth ages 10-17 with CTD and co-occurring ADHD were randomly assigned to the MCBIT group (n = 9) or to a control group where they received traditional comprehensive behavioral intervention for tics (CBIT) therapy (n = 8). Both groups received ten 55-minute weekly treatment sessions, and two 55-minute biweekly relapse prevention sessions. Sixteen of the 17 participants completed the study, and acceptability ratings in both treatment groups were high with no significant differences in expectation of improvement. The MCBIT and CBIT groups in combination showed significant improvement in tic severity, ADHD symptom severity, and tic-related impairment. Group differences were not significant. The results indicate that MCBIT treatment is feasible and acceptable for youth with CTD and ADHD, and is similarly well tolerated relative to traditional CBIT. Results were not sufficiently superior to recommend MCBIT over CBIT for this population. However, given the demonstrated benefit of behavioral treatments that target co-occurring conditions concurrently, continuing to examine novel behavioral approaches that can target tics and related conditions simultaneously and successfully is recommended.
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Affiliation(s)
| | | | | | | | | | - Alyssa Farley
- Boston University Center for Anxiety and Related Disorders
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Adaptation of Behavioral Treatment for Youth with Tourette’s Syndrome and Complex Comorbidity. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2022. [DOI: 10.1007/s40474-022-00266-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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10
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The Developmental Trajectories and Long-Term Outcomes of Childhood Tourette Syndrome: a Systematic Review. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2022. [DOI: 10.1007/s40474-022-00258-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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11
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Ricketts EJ, Woods DW, Espil FM, McGuire JF, Stiede JT, Schild J, Yadegar M, Bennett SM, Specht MW, Chang S, Scahill L, Wilhelm S, Peterson AL, Walkup JT, Piacentini J. Childhood Predictors of Long-Term Tic Severity and Tic Impairment in Tourette's Disorder. Behav Ther 2022; 53:1250-1264. [PMID: 36229120 PMCID: PMC9872160 DOI: 10.1016/j.beth.2022.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 05/29/2022] [Accepted: 07/07/2022] [Indexed: 01/26/2023]
Abstract
Tics peak in late childhood and decline during adolescence. Yet, for some with Tourette's disorder, tics persist into adulthood. We evaluated childhood predictors of adult tic severity and tic impairment, and change over time. Eighty adolescents/adults were evaluated 11 years following a randomized-controlled trial of behavior therapy. An independent evaluator rated tic severity and tic impairment at baseline, posttreatment, and long-term follow-up. At baseline, parents completed demographics/medical history, and youth tic, internalizing, and externalizing symptom ratings. Youth rated premonitory urge severity and family functioning. After controlling for prior tic treatment effects, female sex and higher tic severity predicted higher tic severity in adulthood; and female sex, no stimulant medication use, higher tic severity, and poorer family functioning predicted higher tic impairment. Higher tic severity and premonitory urge severity predicted smaller reductions in tic severity, whereas higher externalizing symptoms predicted greater reduction in tic severity. Female sex predicted smaller reduction in tic impairment, and externalizing symptoms predicted greater reduction in tic impairment. Female sex and childhood tic severity are important predictors of tic severity and tic impairment in adulthood. Family functioning, premonitory urge severity, and tic severity are important modifiable targets for early or targeted intervention to improve long-term outcomes.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - John T Walkup
- Ann and Robert H. Lurie Children's Hospital of Chicago; Northwestern University Feinberg School of Medicine
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12
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Andrén P, Holmsved M, Ringberg H, Wachtmeister V, Isomura K, Aspvall K, Lenhard F, Hall CL, Davies EB, Murphy T, Hollis C, Sampaio F, Feldman I, Bottai M, Serlachius E, Andersson E, Fernández de la Cruz L, Mataix-Cols D. Therapist-Supported Internet-Delivered Exposure and Response Prevention for Children and Adolescents With Tourette Syndrome: A Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2225614. [PMID: 35969401 PMCID: PMC9379743 DOI: 10.1001/jamanetworkopen.2022.25614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE The availability of behavior therapy for individuals with Tourette syndrome (TS) and chronic tic disorder (CTD) is limited. OBJECTIVE To determine the efficacy and cost-effectiveness of internet-delivered exposure and response prevention (ERP) for children and adolescents with TS or CTD. DESIGN, SETTING, AND PARTICIPANTS This single-masked, parallel group, superiority randomized clinical trial with nationwide recruitment was conducted at a research clinic in Stockholm, Sweden. Out of 615 individuals assessed for eligibility, 221 participants meeting diagnostic criteria for TS or CTD and aged 9 to 17 years were included in the study. Enrollment began in April 2019 and ended in April 2021. Data were analyzed between October 2021 and March 2022. INTERVENTIONS Participants were randomized to 10 weeks of therapist-supported internet-delivered ERP for tics (111 participants) or to therapist-supported internet-delivered education for tics (comparator group, 110 participants). MAIN OUTCOMES AND MEASURES The primary outcome was change in tic severity from baseline to the 3-month follow-up as measured by the Total Tic Severity Score of the Yale Global Tic Severity Scale (YGTSS-TTSS). YGTSS-TTSS assessors were masked to treatment allocation. Treatment response was operationalized as a score of 1 ("Very much improved") or 2 ("Much improved") on the Clinical Global Impression-Improvement scale. RESULTS Data loss was minimal, with 216 of 221 participants (97.7%) providing primary outcome data. Among randomized participants (152 [68.8%] boys; mean [SD] age, 12.1 [2.3] years), tic severity improved significantly, with a mean reduction of 6.08 points on the YGTSS-TTSS in the ERP group (mean [SD] at baseline, 22.25 [5.60]; at 3-month follow-up, 16.17 [6.82]) and 5.29 in the comparator (mean [SD] at baseline, 23.01 [5.92]; at 3-month follow-up, 17.72 [7.11]). Intention-to-treat analyses showed that the 2 groups improved similarly over time (interaction effect, -0.53; 95% CI, -1.28 to 0.22; P = .17). Significantly more participants were classified as treatment responders in the ERP group (51 of 108 [47.2%]) than in the comparator group (31 of 108 [28.7%]) at the 3-month follow-up (odds ratio, 2.22; 95% CI, 1.27 to 3.90). ERP resulted in more treatment responders at little additional cost compared with structured education. The incremental cost per quality-adjusted life-year gained was below the Swedish willingness-to-pay threshold, at which ERP had a 66% to 76% probability of being cost-effective. CONCLUSIONS AND RELEVANCE Both interventions were associated with clinically meaningful improvements in tic severity, but ERP led to higher response rates at little additional cost. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03916055.
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Affiliation(s)
- Per Andrén
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Moa Holmsved
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Helene Ringberg
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | | | - Kayoko Isomura
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Kristina Aspvall
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Fabian Lenhard
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Charlotte L. Hall
- Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Queen’s Medical Centre, Nottingham, United Kingdom
- National Institute for Health and Care Research MindTech MedTech Co-operative, Institute of Mental Health, School of Medicine, Division of Psychiatry and Applied Psychology, University of Nottingham, Innovation Park, Triumph Road, Nottingham, United Kingdom
- National Institute for Health and Care Research Nottingham Biomedical Research Centre, Institute of Mental Health, Mental Health and Clinical Neurosciences, University of Nottingham, Innovation Park, Nottingham, United Kingdom
| | - E. Bethan Davies
- Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Queen’s Medical Centre, Nottingham, United Kingdom
- National Institute for Health and Care Research MindTech MedTech Co-operative, Institute of Mental Health, School of Medicine, Division of Psychiatry and Applied Psychology, University of Nottingham, Innovation Park, Triumph Road, Nottingham, United Kingdom
| | - Tara Murphy
- Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
- Psychological and Mental Health Services, Great Ormond Street Hospital for Children National Health Service Foundation Trust, Great Ormond Street, London, United Kingdom
| | - Chris Hollis
- Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Queen’s Medical Centre, Nottingham, United Kingdom
- National Institute for Health and Care Research MindTech MedTech Co-operative, Institute of Mental Health, School of Medicine, Division of Psychiatry and Applied Psychology, University of Nottingham, Innovation Park, Triumph Road, Nottingham, United Kingdom
- National Institute for Health and Care Research Nottingham Biomedical Research Centre, Institute of Mental Health, Mental Health and Clinical Neurosciences, University of Nottingham, Innovation Park, Nottingham, United Kingdom
| | - Filipa Sampaio
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Inna Feldman
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Matteo Bottai
- Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Eva Serlachius
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Child and Adolescent Psychiatry, Department of Clinical Sciences, Medical Faculty, Lund University, Lund, Sweden
| | - Erik Andersson
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Lorena Fernández de la Cruz
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - David Mataix-Cols
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
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13
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Heijerman-Holtgrefe A, Huyser C, Verdellen C, van de Griendt J, Beljaars L, Kan KJ, Lindauer R, Cath D, Hoekstra P, Utens L. Effectiveness of 'Tackle Your Tics', a brief, intensive group-based exposure therapy programme for children with tic disorders: study protocol of a randomised controlled trial. BMJ Open 2022; 12:e058534. [PMID: 35768093 PMCID: PMC9240895 DOI: 10.1136/bmjopen-2021-058534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION This paper outlines the study protocol for the Dutch Tackle Your Tics study in youth with tic disorders. Tourette syndrome and chronic tic disorders are prevalent neurodevelopmental disorders, placing considerable burden on youth and their families. Behavioural treatment is the first-line, evidence-based intervention for tic disorders, but tic reduction and availability remain relatively low. Patient associations stress the need for more accessible high-quality treatments, also focusing on improving quality of life. Therefore, the brief, intensive group-based treatment Tackle Your Tics was developed. METHODS AND ANALYSIS Tackle Your Tics is a 4-day intensive and comprehensive group-based intervention for children and adolescents (9-17 years) with Tourette syndrome or a chronic tic disorder. The programme encompasses exposure and response prevention treatment and additional supporting components (coping strategies, relaxation exercises and parent support). To study the effectiveness of Tackle Your Tics and identify predictors/moderators at baseline, a single-blinded randomised controlled trial (n=104) is conducted, comparing Tackle Your Tics (n=52) with a waiting list condition lasting 3 months (n=52). Assessments are performed at similar time points for both groups: at baseline, after 4 weeks, and at 3 and 6 months of follow-up, on tic severity, quality of life and other psychosocial variables. ETHICS AND DISSEMINATION Ethics approval has been obtained from the medical ethical committee of the Amsterdam Medical Centre (METC nr NL66340.018.18, v3 June 2020). Findings will be presented on national and international conferences, peer-reviewed scientific journals, patient organisation meetings and public media. Patient representatives are fully integrated as part of the research team. If Tackle Your Tics proves to be effective, it can expand evidence-based treatment possibilities for children and adolescents with tic disorders. Identifying the psychosocial predictors/moderators for the effectiveness of this intervention can provide personalised treatment advice in the future. TRIAL REGISTRATION NUMBER NL8052.
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Affiliation(s)
- Annet Heijerman-Holtgrefe
- Department of Child and Adolescent Psychiatry, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Levvel, Academic Center for Child and Adolescent Psychiatry and Specialized Youth Care, Amsterdam, The Netherlands
- Dutch Tourette Association, Haarlem, The Netherlands
| | - Chaim Huyser
- Levvel, Academic Center for Child and Adolescent Psychiatry and Specialized Youth Care, Amsterdam, The Netherlands
| | - Cara Verdellen
- PsyQ Nijmegen/Parnassia Group, Nijmegen, The Netherlands
- TicXperts, Heteren, The Netherlands
| | | | - Laura Beljaars
- Levvel, Academic Center for Child and Adolescent Psychiatry and Specialized Youth Care, Amsterdam, The Netherlands
- Dutch Tourette Association, Haarlem, The Netherlands
- Parnassia Group, The Hague, The Netherlands
| | - Kees-Jan Kan
- Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands
| | - Ramón Lindauer
- Department of Child and Adolescent Psychiatry, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Levvel, Academic Center for Child and Adolescent Psychiatry and Specialized Youth Care, Amsterdam, The Netherlands
| | - Daniëlle Cath
- Department of Specialized Training, GGZ Drenthe, Assen, The Netherlands
- University Medical Center Groningen, Department of Psychiatry, University of Groningen, Groningen, The Netherlands
| | - Pieter Hoekstra
- University Medical Center Groningen, Department of Child and Adolescent Psychiatry, University of Groningen, Groningen, The Netherlands
| | - Lisbeth Utens
- Levvel, Academic Center for Child and Adolescent Psychiatry and Specialized Youth Care, Amsterdam, The Netherlands
- Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands
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14
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Wozniak J, DiSalvo M, Farrell A, Yule A, Joshi G, Cook E, Faraone SV, Biederman J. Can pediatric bipolar disorder be successfully treated when comorbid with conduct disorder? A secondary analysis of clinical trials of risperidone, olanzapine, quetiapine, ziprasidone, and aripiprazole. J Psychopharmacol 2022; 36:637-644. [PMID: 35510655 DOI: 10.1177/02698811221087673] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Pediatric bipolar disorder (BP) is frequently comorbid with conduct disorder (CD) and its presence adds to the morbidity of BP. While there are no known pharmacological treatments for CD, pediatric BP is responsive to treatment with medications initially indicated for the treatment of psychosis, several of which have Food and Drug Administration (FDA) approval for the treatment of pediatric mania. AIMS The main aim of this secondary analysis was to examine whether pediatric BP comorbid with CD responds similarly to treatment with such selected medications. Considering the well-documented morbidity of CD, this finding could have important clinical and public health significance. METHODS We conducted a secondary analysis of six prospective 8-week open-label trials of selected medications (risperidone, olanzapine, quetiapine, ziprasidone, and aripiprazole) using identical methodology in youth with BP with and without comorbid CD. Results: Of 165 youths with BP, 54% (N = 89) met criteria for comorbid CD. The antimanic effects observed did not significantly differ between BP youths with and without comorbid CD, as measured either by a reduction in Young Mania Rating Scale (YMRS) ⩾ 30% or Clinical Global Impression (CGI)-Improvement ⩽ 2 (p = 0.23), or by the more stringent definition of a reduction in YMRS ⩾ 50% (p = 0.61). CONCLUSION Pediatric BP can be effectively treated with the abovementioned medications in the context of comorbid CD. Based on previous research showing that remission of BP is associated with remission of CD, if confirmed, these findings raise the possibility that antimanic treatment of youth with BP comorbid with CD could have secondary benefits in mitigating the morbidity associated with CD. This is a pilot scale finding, the results of which are promising and should be confirmed by larger and long-term follow-up studies.
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Affiliation(s)
- Janet Wozniak
- Clinical and Research Program in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Maura DiSalvo
- Clinical and Research Program in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, MA, USA
| | - Abigail Farrell
- Clinical and Research Program in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, MA, USA
| | - Amy Yule
- Clinical and Research Program in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Gagan Joshi
- Clinical and Research Program in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Emmaline Cook
- Clinical and Research Program in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, MA, USA
| | - Stephen V Faraone
- Department of Psychiatry and Behavioral Sciences, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Joseph Biederman
- Clinical and Research Program in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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15
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Zimmerman-Brenner S, Pilowsky-Peleg T, Rachamim L, Ben-Zvi A, Gur N, Murphy T, Fattal-Valevski A, Rotstein M. Group behavioral interventions for tics and comorbid symptoms in children with chronic tic disorders. Eur Child Adolesc Psychiatry 2022; 31:637-648. [PMID: 33415472 DOI: 10.1007/s00787-020-01702-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 12/05/2020] [Indexed: 11/28/2022]
Abstract
Exposure and Response Prevention (ERP), Habit Reversal Training (HRT) and Comprehensive Behavioral Intervention for Tics (CBIT) are effective in reducing tic severity. ERP and HRT have recently gained primary support in a group setting, while CBIT has not been examined similarly. We compared the efficacy of group-CBIT to group-Educational Intervention for Tics (group-EIT) for tics and comorbid symptoms. Children with Tourette Syndrome (TS) or Chronic Tic Disorder (CTD) were randomized to group-CBIT or group-EIT. Tics and comorbid symptoms were assessed in forty-six children pre- and postintervention, and 3-month later. Yale Global Tic Severity Scale (YGTSS) Motor tic severity decreased following both interventions, and was maintained at follow-up for group-CBIT only. The Parent Tic Questionnaire (PTQ) showed significant decrease in total and motor tic severity following group-CBIT only, a gain maintained three months later. YGTSS impairment score decreased following both interventions and was maintained at follow-up. YGTSS vocal tic severity score increased following both interventions, and then decreased significantly at follow up. Co-morbid symptoms including anxiety, behavioral problems, and aggressive behavior decreased following both interventions. Children with behavioral problems benefitted less while children with higher intellectual ability benefit more from intervention. Both group interventions showed efficacy in reducing tic impairment and comorbid symptoms. Group-CBIT was superior to group-EIT in reducing motor tic severity at 3-month follow-up, showing an advantage for tic-focused treatment. Based on the PTQ, group-CBIT was superior to group-EIT in reducing motor, vocal, and total tic scores, a gain maintained three months later. Clinical trial registry information-Group Intervention for Children with Chronic Tics Syndrome: CBIT vs Psychoeducational Intervention URL: http://clinicaltrials.gov , Identifier: NCT02407951, http://www.controlled-trials.com ).
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Affiliation(s)
- Sharon Zimmerman-Brenner
- Interdisciplinary Center (IDC) Herzliya, Herzliya, Israel.,Tourette Syndrome Association in Israel (TSAI), Tel Aviv-Yaffo, Israel
| | - Tammy Pilowsky-Peleg
- Department of Psychology, The Hebrew University of Jerusalem, Jerusalem, Israel.,Neuropsychology Unit, Schneider Children's Medical Center of Israel, Petach Tikvah, Israel
| | - Lilach Rachamim
- Interdisciplinary Center (IDC) Herzliya, Herzliya, Israel.,Cohen & Harris Resilience Center, Association for Children at Risk, Tel Aviv-Yaffo, Israel
| | - Amit Ben-Zvi
- Interdisciplinary Center (IDC) Herzliya, Herzliya, Israel
| | - Noa Gur
- Department of Psychology, The Hebrew University of Jerusalem, Jerusalem, Israel.,Neuropsychology Unit, Schneider Children's Medical Center of Israel, Petach Tikvah, Israel
| | - Tara Murphy
- Tourette Syndrome Clinic, Great Ormond Street Hospital for Children, NHS Foundation Trust London, London, UK
| | - Aviva Fattal-Valevski
- Pediatric Neurology Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv-Yaffo, Israel
| | - Michael Rotstein
- Pediatric Neurology Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv-Yaffo, Israel. .,Pediatric Movement Disorders Clinic, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv-Yaffo, Israel. .,Pediatric Movement Disorders Service, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, 6 Weizmann St., 6423906, Tel Aviv-Yaffo, Israel.
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16
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Shou S, Li Y, Fan G, Zhang Q, Yan Y, Lv T, Wang J. The Efficacy of Cognitive Behavioral Therapy for Tic Disorder: A Meta-Analysis and a Literature Review. Front Psychol 2022; 13:851250. [PMID: 35401364 PMCID: PMC8987272 DOI: 10.3389/fpsyg.2022.851250] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 02/17/2022] [Indexed: 12/29/2022] Open
Abstract
Background At present, tic disorder has attracted the attention of medical researchers in many countries. More clinicians choose non-drug therapy, especially cognitive-behavioral therapy (CBT) because of the cognitive side effects of drug therapy. However, few studies had assessed its efficacy. It is necessary to have a more comprehensive understanding of the literature quality of CBT and its intervention effect. Methods In this study, MEDLINE, Embase, and Cochrane were searched from the beginning to June 15, 2021 to study the efficacy of -CBT on tic disorder. Only studies using the Yale Global Tic Severity Scale (YGTSS) and the control group were included. Results A total of 12 randomized controlled trials (RCTs), including 536 patients with tic disorders, were identified. The results showed that the effect of CBT was better than that of the control group. The pooled standardized mean difference (SMD) was −0.34 (95% CI: −0.61, −0.07). The effect size of CBT differs from different intervention conditions. In seven studies, the subjects’ motor tic scores were counted. The sample size of the experimental group was 224 and that of the control group was 218. The pooled SMD was −0.43 (95% CI: −0.75, −0.11). Seven studies counted the vocal tic scores of subjects, 224 in the experimental group and 218 in the control group. The pooled SMD was −0.22 (95% CI: −0.54, −0.11). Seven studies counted the tic impairment scores of subjects, 220 in the experimental group and 214 in the control group. The pooled SMD was −0.48 (95% CI: −0.73, −0.23). Conclusion The literature shows that different CBTs can significantly reduce the total score of tic disorder and the score of motor tic, but cannot significantly reduce the score of vocal tic. In the future, more new interventions were needed to improve the symptoms of different patients, especially vocal tic.
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Affiliation(s)
- Songting Shou
- Department of Pediatrics, Dongzhimen Hospital, Beijing, China
| | - Yuanliang Li
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
- Department of Integrative Oncology, China-Japan Friendship Hospital, Beijing, China
| | - Guohui Fan
- Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing, China
| | - Qiang Zhang
- Department of Pediatrics, Dongzhimen Hospital, Beijing, China
| | - Yurou Yan
- Department of Pediatrics, Dongzhimen Hospital, Beijing, China
| | - Tiying Lv
- Department of Pediatrics, Dongzhimen Hospital, Beijing, China
| | - Junhong Wang
- Department of Pediatrics, Dongzhimen Hospital, Beijing, China
- *Correspondence: Junhong Wang,
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17
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Ricketts EJ, Montalbano GE, Burgess HJ, McMakin DL, Coles ME, Piacentini J, Colwell CS. Sleep and chronotype in adults with persistent tic disorders. J Clin Psychol 2022; 78:1516-1539. [PMID: 35150595 DOI: 10.1002/jclp.23323] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 12/22/2021] [Accepted: 01/14/2022] [Indexed: 01/01/2023]
Abstract
OBJECTIVE This study examined sleep disorders and sleep medication use rates, nighttime tics, and sleep and chronotype in relation to tic and co-occurring symptoms in adults with persistent tic disorders (PTDs), including Tourette's disorder (TD). METHODS One hundred twenty-five adult internet survey respondents rated sleep history, sleep, chronotype, tic severity, impairment, attention deficit hyperactivity disorder, obsessive-compulsive symptoms, anxiety, depression, and emotional and behavioral dyscontrol. RESULTS Bruxism, insomnia, tic-related difficulty falling asleep, and melatonin use were commonly endorsed. Sleep disturbance correlated with impairment, obsessive-compulsive symptoms, and emotional and behavioral dyscontrol. Eveningness correlated with vocal and total tic severity only in TD. Controlling for age and sex, age, impairment, and obsessive-compulsive symptoms predicted sleep disturbance, and age and tic severity predicted chronotype. CONCLUSIONS Impairment and obsessive-compulsive symptoms play a role in sleep disturbance in adults with PTDs, and may be intervention targets. Eveningness relates to tic severity, which may suggest the utility of interventions to advance chronotype.
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Affiliation(s)
- Emily J Ricketts
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California, USA
| | - Gabrielle E Montalbano
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California, USA
| | - Helen J Burgess
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Dana L McMakin
- Department of Psychology, Florida International University, Miami, Florida, USA.,Department of Neurology, Nicklaus Children's Hospital, Miami, Florida, USA
| | - Meredith E Coles
- Department of Psychology, State University of New York-Binghamton, Binghamton, New York, USA
| | - John Piacentini
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California, USA
| | - Christopher S Colwell
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California, USA
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18
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Ricketts EJ, Wolicki SB, Danielson ML, Rozenman M, McGuire JF, Piacentini J, Mink JW, Walkup JT, Woods DW, Bitsko RH. Academic, Interpersonal, Recreational, and Family Impairment in Children with Tourette Syndrome and Attention-Deficit/Hyperactivity Disorder. Child Psychiatry Hum Dev 2022; 53:3-15. [PMID: 33385257 PMCID: PMC8245573 DOI: 10.1007/s10578-020-01111-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/09/2020] [Indexed: 02/03/2023]
Abstract
This study describes impairment in academic, interpersonal, recreational, and family financial or occupational domains across children in three mutually exclusive diagnostic groups: ever diagnosed with Tourette syndrome (TS), attention-deficit/hyperactivity disorder (ADHD), and both disorders. In 2014, parents reported on impairment and diagnostic status of children aged 4-17 years (n = 3014). Weighted analysis and pairwise t-tests showed more children with ADHD (with or without TS) experienced impairment in overall school performance, writing, and mathematics, relative to children with TS but not ADHD. More children with TS and ADHD had problematic handwriting relative to children with ADHD but not TS. More children with TS and ADHD had problematic interpersonal relationships relative to those with ADHD but not TS. Children with TS and ADHD had higher mean impairment across domains than children with either TS or ADHD. Findings suggest assessing disorder-specific contributions to impairment could inform targeted interventions for TS and ADHD.
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Affiliation(s)
- Emily J. Ricketts
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA
| | - Sara Beth Wolicki
- Oak Ridge Institute for Science and Education, Centers for Disease Control and Prevention Research Participation Programs, Atlanta GA,Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | - Melissa L. Danielson
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | | | - Joseph F. McGuire
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - John Piacentini
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA
| | | | - John T. Walkup
- Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL,Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | | - Rebecca H. Bitsko
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
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Andrén P, Jakubovski E, Murphy TL, Woitecki K, Tarnok Z, Zimmerman-Brenner S, van de Griendt J, Debes NM, Viefhaus P, Robinson S, Roessner V, Ganos C, Szejko N, Müller-Vahl KR, Cath D, Hartmann A, Verdellen C. European clinical guidelines for Tourette syndrome and other tic disorders-version 2.0. Part II: psychological interventions. Eur Child Adolesc Psychiatry 2022; 31:403-423. [PMID: 34313861 PMCID: PMC8314030 DOI: 10.1007/s00787-021-01845-z] [Citation(s) in RCA: 52] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 07/07/2021] [Indexed: 12/20/2022]
Abstract
Part II of the European clinical guidelines for Tourette syndrome and other tic disorders (ECAP journal, 2011) provides updated information and recommendations for psychological interventions for individuals with tic disorders, created by a working group of the European Society for the Study of Tourette Syndrome (ESSTS). A systematic literature search was conducted to obtain original studies of psychological interventions for tic disorders, published since the initial European clinical guidelines were issued. Relevant studies were identified using computerized searches of the MEDLINE and PsycINFO databases for the years 2011-2019 and a manual search for the years 2019-2021. Based on clinical consensus, psychoeducation is recommended as an initial intervention regardless of symptom severity. According to a systematic literature search, most evidence was found for Habit Reversal Training (HRT), primarily the expanded package Comprehensive Behavioral Intervention for Tics (CBIT). Evidence was also found for Exposure and Response Prevention (ERP), but to a lesser degree of certainty than HRT/CBIT due to fewer studies. Currently, cognitive interventions and third-wave interventions are not recommended as stand-alone treatments for tic disorders. Several novel treatment delivery formats are currently being evaluated, of which videoconference delivery of HRT/CBIT has the most evidence to date. To summarize, when psychoeducation alone is insufficient, both HRT/CBIT and ERP are recommended as first-line interventions for tic disorders. As part of the development of the clinical guidelines, a survey is reported from ESSTS members and other tic disorder experts on preference, use and availability of psychological interventions for tic disorders.
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Affiliation(s)
- Per Andrén
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, and Stockholm Health Care Services, Region Stockholm, Gävlegatan 22, 113 30, Stockholm, Sweden.
| | - Ewgeni Jakubovski
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Tara L Murphy
- Tic Disorder Clinic, Great Ormond Street Hospital NHS Foundation Trust, London, WC1 3JH, UK
| | - Katrin Woitecki
- School of Child and Adolescent Cognitive Behavior Therapy (AKiP), University Hospital, Cologne, Germany
| | - Zsanett Tarnok
- Vadaskert Child and Adolescent Psychiatry, Budapest, Hungary
| | - Sharon Zimmerman-Brenner
- Baruch Ivcher School of Psychology, The Interdisciplinary Center (IDC) Herzliya, Herzliya, Israel
| | | | - Nanette Mol Debes
- Department of Pediatrics, Herlev University Hospital, Herlev, Denmark
| | - Paula Viefhaus
- School of Child and Adolescent Cognitive Behavior Therapy (AKiP), University Hospital, Cologne, Germany
| | - Sally Robinson
- Tic and Neurodevelopmental Movement Service (TANDeM), Children's Neurosciences, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Veit Roessner
- Department of Child and Adolescent Psychiatry, TU Dresden, Dresden, Germany
| | - Christos Ganos
- Department of Neurology, Charité University Medicine Berlin, Berlin, Germany
| | - Natalia Szejko
- Department of Neurology, Medical University of Warsaw, Warsaw, Poland
- Department of Bioethics, Medical University of Warsaw, Warsaw, Poland
- Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale School of Medicine, New Haven, USA
| | - Kirsten R Müller-Vahl
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Danielle Cath
- Department of Psychiatry, University Medical Center Groningen, Rijks Universiteit Groningen, GGZ Drenthe Mental Health Institution, Assen, The Netherlands
| | - Andreas Hartmann
- Department of Neurology, Hôpital de La Pitié-Salpêtrière, 75013, Paris, France
| | - Cara Verdellen
- PsyQ Nijmegen, Outpatient Treatment Center, Parnassia Group, Den Haag, The Netherlands
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20
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Ashurova M, Budman C, Coffey BJ. Ticked Off: Anger Outbursts and Aggressive Symptoms in Tourette Disorder. Child Adolesc Psychiatr Clin N Am 2021; 30:361-373. [PMID: 33743944 DOI: 10.1016/j.chc.2020.10.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Tourette disorder is a complex neuropsychiatric syndrome of childhood onset characterized by multiple motor and phonic tics and is associated with high rates of psychiatric comorbidity. Symptoms of impulsive aggression (explosive outbursts or "rage") are commonly encountered in the clinical setting, cause significant morbidity, and pose diagnostic and treatment challenges. These symptoms may be multifactorial in etiology and result from a complex interplay of illness severity and psychosocial factors. Treatment strategies require careful differential diagnostic evaluation and include both behavioral and pharmacologic interventions.
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Affiliation(s)
- Marianna Ashurova
- Zucker Hillside Hospital, ACP Building Basement, 75-59 263rd Street, Glen Oaks, NY 11004, USA; Child & Adolescent Psychiatry Consultation Liaison Service, Cohens Children's Medical Center, 268-01 76th Avenue, New Hyde Park, NY 11040, USA.
| | - Cathy Budman
- Long Island Center for Tourette, 1615 Northern Boulevard, Suite #306, Manhasset, NY 11030, USA; Zucker School of Medicine, 500 Hofstra Boulevard, Hempstead, NY 11549, USA
| | - Barbara J Coffey
- Department of Psychiatry and Behavioral Sciences, Child and Adolescent Psychiatry, Tourette Association Center of Excellence, University of Miami Miller School of Medicine, 1120 Northwest Fourteenth Street, Suite 1442, Miami, FL 33136, USA
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Heijerman-Holtgrefe AP, Verdellen CWJ, van de Griendt JMTM, Beljaars LPL, Kan KJ, Cath D, Hoekstra PJ, Huyser C, Utens EMWJ. Tackle your Tics: pilot findings of a brief, intensive group-based exposure therapy program for children with tic disorders. Eur Child Adolesc Psychiatry 2021; 30:461-473. [PMID: 32436035 PMCID: PMC8019419 DOI: 10.1007/s00787-020-01532-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 04/06/2020] [Indexed: 10/31/2022]
Abstract
Tourette syndrome (TS) and other chronic tic disorders (CTD) are prevalent neurodevelopmental disorders, which can have a huge burden on families and society. Behavioral treatment is a first-line intervention for tic disorders. Despite demonstrated efficacy, tic reduction and utilization rates of behavioral treatment remain relatively low. Patient associations point to an urgent need for easy-to-undergo treatments that focus both on tic reduction and improvement of quality of life. To enhance treatment outcome and overcome treatment barriers, this pilot study's aim was to investigate the feasibility and preliminary results of a brief, intensive group-based treatment. Tackle your Tics is a 4-day intensive and comprehensive group-based program for children and adolescents (9-17 years) with a tic disorder, consisting of exposure and response prevention (ERP) treatment and additional supporting components, such as coping strategies, relaxing activities and parent support. Assessments were performed pre- and post-treatment and at 2 months follow-up, to test outcomes on tic severity and quality of life, and explore premonitory urges, emotional and behavioral functioning and treatment satisfaction (N = 14, of whom 13 completed the treatment). Parents and children rated this treatment positive on a treatment satisfaction questionnaire. On tic severity (Yale Global Tic Severity Scale) and quality of life (Gilles de la Tourette Syndrome Quality of Life Scale for children and adolescents), improvements between pre-treatment and follow-up were found. Intensive ERP in group format is promising as a feasible treatment to improve both tic severity as well as quality of life. Larger controlled trials are needed to establish its effectiveness.
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Affiliation(s)
- A. P. Heijerman-Holtgrefe
- Dutch Tourette Association, Alkmaar, The Netherlands ,Dutch Knowledge Centre for Child and Adolescent Psychiatry, Utrecht, The Netherlands ,Amsterdam UMC University Medical Centers, Amsterdam, The Netherlands
| | - C. W. J. Verdellen
- Parnassia Group/PsyQ, Nijmegen, The Netherlands ,TicXperts, Heteren, The Netherlands
| | | | - L. P. L. Beljaars
- Dutch Tourette Association, Alkmaar, The Netherlands ,Parnassia Group, Den Haag, The Netherlands
| | - K. J. Kan
- grid.7177.60000000084992262Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands
| | - D. Cath
- grid.468637.80000 0004 0465 6592Department of Specialized Training, GGZ Drenthe, Assen, The Netherlands ,grid.4494.d0000 0000 9558 4598University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - P. J. Hoekstra
- grid.4494.d0000 0000 9558 4598Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - C. Huyser
- grid.491096.3De Bascule, Academic Centre for Child and Adolescent Psychiatry, Amsterdam, The Netherlands
| | - E. M. W. J. Utens
- grid.7177.60000000084992262Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands ,grid.491096.3De Bascule, Academic Centre for Child and Adolescent Psychiatry, Amsterdam, The Netherlands ,grid.416135.4Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC, Sophia Children’s Hospital, Rotterdam, The Netherlands
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McGuire JF, Piacentini J, Storch EA, Ricketts EJ, Woods DW, Peterson AL, Walkup JT, Wilhelm S, Ramsey K, Essoe JKY, Himle MB, Lewin AB, Chang S, Murphy TK, McCracken JT, Scahill L. Defining tic severity and tic impairment in Tourette Disorder. J Psychiatr Res 2021; 133:93-100. [PMID: 33338735 PMCID: PMC7867408 DOI: 10.1016/j.jpsychires.2020.12.040] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 12/07/2020] [Accepted: 12/10/2020] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Treatment guidelines for Tourette's Disorder (TD) are based on patients' degree of tic severity and impairment. However, clear benchmarks for determining tic severity and impairment have not been established. This study examined benchmarks of tic severity and tic impairment using the Yale Global Tic Severity Scale (YGTSS) and the Clinical Global Impression of Severity (CGI-S). METHOD Individuals with TD or another Tic Disorder (N = 519) recruited across nine sites were administered a diagnostic interview, the YGTSS, and the CGI-S. Correlations and trend analyses contrasted YGTSS scores across CGI-S ratings. A logistic regression model examined predictive benchmarks for tic severity, tic impairment, and global severity. Model classifications were compared against CGI-S ratings, and agreement was examined using kappa. RESULTS Spearman correlations between the CGI-S and YGTSS scores ranged from 0.54 to 0.63 (p < 0.001). Greater CGI-S ratings were associated with a linear stepwise increase in YGTSS Total Tic scores, Impairment scores, and Global Severity scores. Despite moderate-to-strong associations (ρ = 0.45-0.56, p < 0.001) between the CGI-S and predictive logistical regression models, only fair agreement was achieved when applying classification benchmarks (κ = 0.21-0.32, p < 0.001). CONCLUSIONS CGI-S ratings are useful to characterize benchmarks for tic severity, tic impairment, and global severity on the YGTSS. Logistic regression model benchmarks had only fair agreement with the CGI-S and underscore the heterogeneity of TD symptoms. Collectively, findings offer guidance on the delineation of tic severity categorizations to apply evidence-based treatment recommendations.
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Affiliation(s)
- Joseph F McGuire
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, USA; Semel Institute of Neuroscience and Human Behavior, University of California Los Angeles, USA.
| | - John Piacentini
- Semel Institute of Neuroscience and Human Behavior, University of California Los Angeles, USA
| | - Eric A Storch
- Department of Psychiatry, Baylor College of Medicine, USA
| | - Emily J Ricketts
- Semel Institute of Neuroscience and Human Behavior, University of California Los Angeles, USA
| | | | - Alan L Peterson
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, USA; Research and Development Service, South Texas Veterans Health Care System, USA; Department of Psychology, University of Texas at San Antonio, USA
| | - John T Walkup
- Ann and Robert H. Lurie Children's Hospital of Chicago, USA
| | - Sabine Wilhelm
- Massachusetts General Hospital and Harvard Medical School, USA
| | - Kesley Ramsey
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, USA
| | - Joey K-Y Essoe
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, USA
| | | | - Adam B Lewin
- Departments of Pediatrics, Psychiatry and Behavioral Neuroscience, University of South Florida, USA
| | - Susanna Chang
- Semel Institute of Neuroscience and Human Behavior, University of California Los Angeles, USA
| | - Tanya K Murphy
- Departments of Pediatrics, Psychiatry and Behavioral Neuroscience, University of South Florida, USA; All Children's Hospital, Johns Hopkins Medicine, USA
| | - James T McCracken
- Semel Institute of Neuroscience and Human Behavior, University of California Los Angeles, USA
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24
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McGuire JF, Ricketts EJ, Scahill L, Wilhelm S, Woods DW, Piacentini J, Walkup JT, Peterson AL. Effect of behavior therapy for Tourette's disorder on psychiatric symptoms and functioning in adults. Psychol Med 2020; 50:2046-2056. [PMID: 31451122 PMCID: PMC7190082 DOI: 10.1017/s0033291719002150] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Although behavior therapy reduces tic severity, it is unknown whether it improves co-occurring psychiatric symptoms and functional outcomes for adults with Tourette's disorder (TD). This information is essential for effective treatment planning. This study examined the effects of behavior therapy on psychiatric symptoms and functional outcomes in older adolescents and adults with TD. METHOD A total of 122 individuals with TD or a chronic tic disorder participated in a clinical trial comparing behavior therapy to psychoeducation and supportive therapy. At baseline, posttreatment, and follow-up visits, participants completed assessments of tic severity, co-occurring symptoms (inattention, impulsiveness, hyperactivity, anger, anxiety, depression, obsessions, and compulsions), and psychosocial functioning. We compared changes in tic severity, psychiatric symptoms, and functional outcomes using repeated measure and one-way analysis of variance. RESULTS At posttreatment, participants receiving behavior therapy reported greater reductions in obsessions compared to participants in supportive therapy ($\eta _p^2 $ = 0.04, p = 0.04). Across treatments, a positive treatment response on the Clinical Global Impression of Improvement scale was associated with a reduced disruption in family life ($\eta _p^2 $ = 0.05, p = 0.02) and improved functioning in a parental role ($\eta _p^2 $ = 0.37, p = 0.02). Participants who responded positively to eight sessions of behavior therapy had an improvement in tic severity ($\eta _p^2 $ = 0.75, p < 0.001), inattention ($\eta _p^2 $ = 0.48, p < 0.02), and functioning ($\eta _p^2 $ = 0.39-0.42, p < 0.03-0.04) at the 6-month follow-up. CONCLUSION Behavior therapy has a therapeutic benefit for co-occurring obsessive symptoms in the short-term, and reduces tic severity and disability in adults with TD over time. Additional treatments may be necessary to address co-occurring symptoms and improve functional outcomes.
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Affiliation(s)
- Joseph F. McGuire
- Division of Child and Adolescent Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Emily J. Ricketts
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry, University of California Los Angeles, Los Angeles, California
| | - Lawrence Scahill
- Marcus Autism Center, Emory University School of Medicine, Atlanta, Georgia
| | - Sabine Wilhelm
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Douglas W. Woods
- Department of Psychology, Marquette University, Milwaukee, Wisconsin
| | - John Piacentini
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry, University of California Los Angeles, Los Angeles, California
| | | | - Alan L. Peterson
- Department of Psychiatry, University of Texas Health Science at Center, San Antonio, Texas
- Department of Psychology, University of Texas at San Antonio, San Antonio, Texas
- South Texas Veterans Health Care System, San Antonio, Texas
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25
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Bitsko RH, Danielson ML, Leeb RT, Bergland B, Fuoco MJ, Ghandour RM, Lewin AB. Indicators of Social Competence and Social Participation Among US Children With Tourette Syndrome. J Child Neurol 2020; 35:612-620. [PMID: 32515671 PMCID: PMC7478331 DOI: 10.1177/0883073820924257] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Children with Tourette syndrome often have behavioral and social difficulties, which may be associated with co-occurring mental, emotional, or behavioral disorders. This study investigated social competence, including behavioral problems and social skills, and social activities between children with and without Tourette syndrome using a nationally representative sample. In the 2007 National Survey of Children's Health, parents reported on health care provider diagnosis of Tourette syndrome, co-occurring mental, emotional, or behavioral disorders, and indicators of social competence. Children aged 6-17 years with and without Tourette syndrome were compared. Most (78.7%) children with Tourette syndrome had a co-occurring mental, emotional, or behavioral disorder. Children with Tourette syndrome had significantly lower social competence, exhibited by higher levels of behavior problems (mean score 11.6 for Tourette syndrome and 9.0 for no Tourette syndrome) and lower levels of social skills (mean 15.3) than children without a Tourette syndrome diagnosis (mean 17.1); however, these associations were no longer significant after controlling for co-occurring mental, emotional, or behavioral disorders. Moderate to severe Tourette syndrome was associated with the highest ratings of behavioral problems and the lowest ratings of social skills. Children with and without Tourette syndrome were equally likely to participate in social activities; the difference for children with moderate to severe Tourette syndrome being less likely to participate in activities compared to children with mild Tourette syndrome had a chi-square test P value of .05. In conclusion, Tourette syndrome was associated with lower social competence, particularly for children with moderate to severe Tourette syndrome. Monitoring social functioning and co-occurring conditions among children with Tourette syndrome, and referral for evidence-based interventions when needed, may benefit overall health and functioning.
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Affiliation(s)
- Rebecca H. Bitsko
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Melissa L. Danielson
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Rebecca T. Leeb
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Brita Bergland
- Oak Ridge Institute for Science and Education, Centers for Disease Control and Prevention Research Participation Programs, Oak Ridge, TN, USA
| | - Morgan J. Fuoco
- Oak Ridge Institute for Science and Education, Centers for Disease Control and Prevention Research Participation Programs, Oak Ridge, TN, USA
| | - Reem M. Ghandour
- Office of Epidemiology and Research, Maternal and Child Health Bureau, Health Resources and Services Administration, Rockville, MD, USA
| | - Adam B. Lewin
- University of South Florida’s Rothman Center for Neuropsychiatry, St Petersburg, FL, USA
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26
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Quast LF, Rosenthal LD, Cushman GK, Gutiérrez-Colina AM, Braley EI, Kardon P, Blount RL. Relations Between Tic Severity, Emotion Regulation, and Social Outcomes in Youth with Tourette Syndrome. Child Psychiatry Hum Dev 2020; 51:366-376. [PMID: 31863267 DOI: 10.1007/s10578-019-00948-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 12/07/2019] [Accepted: 12/10/2019] [Indexed: 12/01/2022]
Abstract
This study examined associations between tic severity, emotion regulation, social functioning, and social impairment in youth with Tourette Syndrome (TS). Emotion regulation was examined as a mediator between tic severity and social outcomes. Seventy-seven caregivers of youth with TS (M age = 13.1 years; SD = 2.29) were administered proxy-report measures of tic severity, emotion regulation, social functioning, and social impairment. Total and motor tic severity were negatively associated with emotion regulation and social functioning, and positively associated with social impairment (r's = 0.23 to 0.43). Vocal tic severity was not related to emotion regulation or social functioning, but was positively associated with social impairment (r = 0.36). Emotion regulation mediated the relations between total tic severity and both social outcomes, and motor tic severity and both social outcomes. Interventions that target emotion regulation would likely be a beneficial adjunctive therapy for youth with TS, and may result in improved social outcomes.
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Affiliation(s)
- Lauren F Quast
- Department of Psychology, University of Georgia, 125 Baldwin St., Athens, GA, 30602, USA.
| | - Lindsay D Rosenthal
- Department of Psychology, University of Georgia, 125 Baldwin St., Athens, GA, 30602, USA
| | - Grace K Cushman
- Department of Psychology, University of Georgia, 125 Baldwin St., Athens, GA, 30602, USA
| | - Ana M Gutiérrez-Colina
- Department of Psychology, University of Georgia, 125 Baldwin St., Athens, GA, 30602, USA
| | - Emily I Braley
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
| | - Patricia Kardon
- Tourette Information Center and Support (TICS) of Georgia, Inc., Atlanta, GA, USA
| | - Ronald L Blount
- Department of Psychology, University of Georgia, 125 Baldwin St., Athens, GA, 30602, USA
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Pringsheim T, Okun MS, Müller-Vahl K, Martino D, Jankovic J, Cavanna AE, Woods DW, Robinson M, Jarvie E, Roessner V, Oskoui M, Holler-Managan Y, Piacentini J. Practice guideline recommendations summary: Treatment of tics in people with Tourette syndrome and chronic tic disorders. Neurology 2019; 92:896-906. [PMID: 31061208 DOI: 10.1212/wnl.0000000000007466] [Citation(s) in RCA: 198] [Impact Index Per Article: 39.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 11/21/2018] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE To make recommendations on the assessment and management of tics in people with Tourette syndrome and chronic tic disorders. METHODS A multidisciplinary panel consisting of 9 physicians, 2 psychologists, and 2 patient representatives developed practice recommendations, integrating findings from a systematic review and following an Institute of Medicine-compliant process to ensure transparency and patient engagement. Recommendations were supported by structured rationales, integrating evidence from the systematic review, related evidence, principles of care, and inferences from evidence. RESULTS Forty-six recommendations were made regarding the assessment and management of tics in individuals with Tourette syndrome and chronic tic disorders. These include counseling recommendations on the natural history of tic disorders, psychoeducation for teachers and peers, assessment for comorbid disorders, and periodic reassessment of the need for ongoing therapy. Treatment options should be individualized, and the choice should be the result of a collaborative decision among patient, caregiver, and clinician, during which the benefits and harms of individual treatments as well as the presence of comorbid disorders are considered. Treatment options include watchful waiting, the Comprehensive Behavioral Intervention for Tics, and medication; recommendations are provided on how to offer and monitor these therapies. Recommendations on the assessment for and use of deep brain stimulation in adults with severe, treatment-refractory tics are provided as well as suggestions for future research.
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Affiliation(s)
- Tamara Pringsheim
- From the Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences (T.P., D.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Departments of Neurology and Neurosurgery (M.S.O.), Fixel Center for Neurological Diseases, University of Florida, Gainesville; Department of Psychiatry, Social Psychiatry, and Psychotherapy (K.M.-V.), Hannover Medical School, Germany; Department of Neurology (J.J.), Baylor College of Medicine, Houston, TX; Department of Neuropsychiatry (A.E.C.), BSMHFT, University of Birmingham and Aston University, UK; Department of Psychology (D.W.W.), Marquette University, Milwaukee, WI; Massachusetts Chapter (M.R.), Tourette Association of America, Bayside, NY; Waisman Center (E.J.), University Center for Excellence in Developmental Disabilities, University of Wisconsin, Madison; Technische Universitaet Dresden (V.R.), Germany; Departments of Pediatric and Neurology/Neurosurgery (M.O.), McGill University, Montréal, Canada; Department of Pediatrics (Neurology) (Y.H.-M.), Northwestern University Feinberg School of Medicine, Chicago, IL; and Department of Psychiatry and Biobehavioral Sciences (J.P.), Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles
| | - Michael S Okun
- From the Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences (T.P., D.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Departments of Neurology and Neurosurgery (M.S.O.), Fixel Center for Neurological Diseases, University of Florida, Gainesville; Department of Psychiatry, Social Psychiatry, and Psychotherapy (K.M.-V.), Hannover Medical School, Germany; Department of Neurology (J.J.), Baylor College of Medicine, Houston, TX; Department of Neuropsychiatry (A.E.C.), BSMHFT, University of Birmingham and Aston University, UK; Department of Psychology (D.W.W.), Marquette University, Milwaukee, WI; Massachusetts Chapter (M.R.), Tourette Association of America, Bayside, NY; Waisman Center (E.J.), University Center for Excellence in Developmental Disabilities, University of Wisconsin, Madison; Technische Universitaet Dresden (V.R.), Germany; Departments of Pediatric and Neurology/Neurosurgery (M.O.), McGill University, Montréal, Canada; Department of Pediatrics (Neurology) (Y.H.-M.), Northwestern University Feinberg School of Medicine, Chicago, IL; and Department of Psychiatry and Biobehavioral Sciences (J.P.), Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles
| | - Kirsten Müller-Vahl
- From the Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences (T.P., D.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Departments of Neurology and Neurosurgery (M.S.O.), Fixel Center for Neurological Diseases, University of Florida, Gainesville; Department of Psychiatry, Social Psychiatry, and Psychotherapy (K.M.-V.), Hannover Medical School, Germany; Department of Neurology (J.J.), Baylor College of Medicine, Houston, TX; Department of Neuropsychiatry (A.E.C.), BSMHFT, University of Birmingham and Aston University, UK; Department of Psychology (D.W.W.), Marquette University, Milwaukee, WI; Massachusetts Chapter (M.R.), Tourette Association of America, Bayside, NY; Waisman Center (E.J.), University Center for Excellence in Developmental Disabilities, University of Wisconsin, Madison; Technische Universitaet Dresden (V.R.), Germany; Departments of Pediatric and Neurology/Neurosurgery (M.O.), McGill University, Montréal, Canada; Department of Pediatrics (Neurology) (Y.H.-M.), Northwestern University Feinberg School of Medicine, Chicago, IL; and Department of Psychiatry and Biobehavioral Sciences (J.P.), Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles
| | - Davide Martino
- From the Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences (T.P., D.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Departments of Neurology and Neurosurgery (M.S.O.), Fixel Center for Neurological Diseases, University of Florida, Gainesville; Department of Psychiatry, Social Psychiatry, and Psychotherapy (K.M.-V.), Hannover Medical School, Germany; Department of Neurology (J.J.), Baylor College of Medicine, Houston, TX; Department of Neuropsychiatry (A.E.C.), BSMHFT, University of Birmingham and Aston University, UK; Department of Psychology (D.W.W.), Marquette University, Milwaukee, WI; Massachusetts Chapter (M.R.), Tourette Association of America, Bayside, NY; Waisman Center (E.J.), University Center for Excellence in Developmental Disabilities, University of Wisconsin, Madison; Technische Universitaet Dresden (V.R.), Germany; Departments of Pediatric and Neurology/Neurosurgery (M.O.), McGill University, Montréal, Canada; Department of Pediatrics (Neurology) (Y.H.-M.), Northwestern University Feinberg School of Medicine, Chicago, IL; and Department of Psychiatry and Biobehavioral Sciences (J.P.), Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles
| | - Joseph Jankovic
- From the Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences (T.P., D.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Departments of Neurology and Neurosurgery (M.S.O.), Fixel Center for Neurological Diseases, University of Florida, Gainesville; Department of Psychiatry, Social Psychiatry, and Psychotherapy (K.M.-V.), Hannover Medical School, Germany; Department of Neurology (J.J.), Baylor College of Medicine, Houston, TX; Department of Neuropsychiatry (A.E.C.), BSMHFT, University of Birmingham and Aston University, UK; Department of Psychology (D.W.W.), Marquette University, Milwaukee, WI; Massachusetts Chapter (M.R.), Tourette Association of America, Bayside, NY; Waisman Center (E.J.), University Center for Excellence in Developmental Disabilities, University of Wisconsin, Madison; Technische Universitaet Dresden (V.R.), Germany; Departments of Pediatric and Neurology/Neurosurgery (M.O.), McGill University, Montréal, Canada; Department of Pediatrics (Neurology) (Y.H.-M.), Northwestern University Feinberg School of Medicine, Chicago, IL; and Department of Psychiatry and Biobehavioral Sciences (J.P.), Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles
| | - Andrea E Cavanna
- From the Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences (T.P., D.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Departments of Neurology and Neurosurgery (M.S.O.), Fixel Center for Neurological Diseases, University of Florida, Gainesville; Department of Psychiatry, Social Psychiatry, and Psychotherapy (K.M.-V.), Hannover Medical School, Germany; Department of Neurology (J.J.), Baylor College of Medicine, Houston, TX; Department of Neuropsychiatry (A.E.C.), BSMHFT, University of Birmingham and Aston University, UK; Department of Psychology (D.W.W.), Marquette University, Milwaukee, WI; Massachusetts Chapter (M.R.), Tourette Association of America, Bayside, NY; Waisman Center (E.J.), University Center for Excellence in Developmental Disabilities, University of Wisconsin, Madison; Technische Universitaet Dresden (V.R.), Germany; Departments of Pediatric and Neurology/Neurosurgery (M.O.), McGill University, Montréal, Canada; Department of Pediatrics (Neurology) (Y.H.-M.), Northwestern University Feinberg School of Medicine, Chicago, IL; and Department of Psychiatry and Biobehavioral Sciences (J.P.), Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles
| | - Douglas W Woods
- From the Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences (T.P., D.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Departments of Neurology and Neurosurgery (M.S.O.), Fixel Center for Neurological Diseases, University of Florida, Gainesville; Department of Psychiatry, Social Psychiatry, and Psychotherapy (K.M.-V.), Hannover Medical School, Germany; Department of Neurology (J.J.), Baylor College of Medicine, Houston, TX; Department of Neuropsychiatry (A.E.C.), BSMHFT, University of Birmingham and Aston University, UK; Department of Psychology (D.W.W.), Marquette University, Milwaukee, WI; Massachusetts Chapter (M.R.), Tourette Association of America, Bayside, NY; Waisman Center (E.J.), University Center for Excellence in Developmental Disabilities, University of Wisconsin, Madison; Technische Universitaet Dresden (V.R.), Germany; Departments of Pediatric and Neurology/Neurosurgery (M.O.), McGill University, Montréal, Canada; Department of Pediatrics (Neurology) (Y.H.-M.), Northwestern University Feinberg School of Medicine, Chicago, IL; and Department of Psychiatry and Biobehavioral Sciences (J.P.), Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles
| | - Michael Robinson
- From the Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences (T.P., D.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Departments of Neurology and Neurosurgery (M.S.O.), Fixel Center for Neurological Diseases, University of Florida, Gainesville; Department of Psychiatry, Social Psychiatry, and Psychotherapy (K.M.-V.), Hannover Medical School, Germany; Department of Neurology (J.J.), Baylor College of Medicine, Houston, TX; Department of Neuropsychiatry (A.E.C.), BSMHFT, University of Birmingham and Aston University, UK; Department of Psychology (D.W.W.), Marquette University, Milwaukee, WI; Massachusetts Chapter (M.R.), Tourette Association of America, Bayside, NY; Waisman Center (E.J.), University Center for Excellence in Developmental Disabilities, University of Wisconsin, Madison; Technische Universitaet Dresden (V.R.), Germany; Departments of Pediatric and Neurology/Neurosurgery (M.O.), McGill University, Montréal, Canada; Department of Pediatrics (Neurology) (Y.H.-M.), Northwestern University Feinberg School of Medicine, Chicago, IL; and Department of Psychiatry and Biobehavioral Sciences (J.P.), Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles
| | - Elizabeth Jarvie
- From the Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences (T.P., D.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Departments of Neurology and Neurosurgery (M.S.O.), Fixel Center for Neurological Diseases, University of Florida, Gainesville; Department of Psychiatry, Social Psychiatry, and Psychotherapy (K.M.-V.), Hannover Medical School, Germany; Department of Neurology (J.J.), Baylor College of Medicine, Houston, TX; Department of Neuropsychiatry (A.E.C.), BSMHFT, University of Birmingham and Aston University, UK; Department of Psychology (D.W.W.), Marquette University, Milwaukee, WI; Massachusetts Chapter (M.R.), Tourette Association of America, Bayside, NY; Waisman Center (E.J.), University Center for Excellence in Developmental Disabilities, University of Wisconsin, Madison; Technische Universitaet Dresden (V.R.), Germany; Departments of Pediatric and Neurology/Neurosurgery (M.O.), McGill University, Montréal, Canada; Department of Pediatrics (Neurology) (Y.H.-M.), Northwestern University Feinberg School of Medicine, Chicago, IL; and Department of Psychiatry and Biobehavioral Sciences (J.P.), Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles
| | - Veit Roessner
- From the Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences (T.P., D.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Departments of Neurology and Neurosurgery (M.S.O.), Fixel Center for Neurological Diseases, University of Florida, Gainesville; Department of Psychiatry, Social Psychiatry, and Psychotherapy (K.M.-V.), Hannover Medical School, Germany; Department of Neurology (J.J.), Baylor College of Medicine, Houston, TX; Department of Neuropsychiatry (A.E.C.), BSMHFT, University of Birmingham and Aston University, UK; Department of Psychology (D.W.W.), Marquette University, Milwaukee, WI; Massachusetts Chapter (M.R.), Tourette Association of America, Bayside, NY; Waisman Center (E.J.), University Center for Excellence in Developmental Disabilities, University of Wisconsin, Madison; Technische Universitaet Dresden (V.R.), Germany; Departments of Pediatric and Neurology/Neurosurgery (M.O.), McGill University, Montréal, Canada; Department of Pediatrics (Neurology) (Y.H.-M.), Northwestern University Feinberg School of Medicine, Chicago, IL; and Department of Psychiatry and Biobehavioral Sciences (J.P.), Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles
| | - Maryam Oskoui
- From the Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences (T.P., D.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Departments of Neurology and Neurosurgery (M.S.O.), Fixel Center for Neurological Diseases, University of Florida, Gainesville; Department of Psychiatry, Social Psychiatry, and Psychotherapy (K.M.-V.), Hannover Medical School, Germany; Department of Neurology (J.J.), Baylor College of Medicine, Houston, TX; Department of Neuropsychiatry (A.E.C.), BSMHFT, University of Birmingham and Aston University, UK; Department of Psychology (D.W.W.), Marquette University, Milwaukee, WI; Massachusetts Chapter (M.R.), Tourette Association of America, Bayside, NY; Waisman Center (E.J.), University Center for Excellence in Developmental Disabilities, University of Wisconsin, Madison; Technische Universitaet Dresden (V.R.), Germany; Departments of Pediatric and Neurology/Neurosurgery (M.O.), McGill University, Montréal, Canada; Department of Pediatrics (Neurology) (Y.H.-M.), Northwestern University Feinberg School of Medicine, Chicago, IL; and Department of Psychiatry and Biobehavioral Sciences (J.P.), Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles
| | - Yolanda Holler-Managan
- From the Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences (T.P., D.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Departments of Neurology and Neurosurgery (M.S.O.), Fixel Center for Neurological Diseases, University of Florida, Gainesville; Department of Psychiatry, Social Psychiatry, and Psychotherapy (K.M.-V.), Hannover Medical School, Germany; Department of Neurology (J.J.), Baylor College of Medicine, Houston, TX; Department of Neuropsychiatry (A.E.C.), BSMHFT, University of Birmingham and Aston University, UK; Department of Psychology (D.W.W.), Marquette University, Milwaukee, WI; Massachusetts Chapter (M.R.), Tourette Association of America, Bayside, NY; Waisman Center (E.J.), University Center for Excellence in Developmental Disabilities, University of Wisconsin, Madison; Technische Universitaet Dresden (V.R.), Germany; Departments of Pediatric and Neurology/Neurosurgery (M.O.), McGill University, Montréal, Canada; Department of Pediatrics (Neurology) (Y.H.-M.), Northwestern University Feinberg School of Medicine, Chicago, IL; and Department of Psychiatry and Biobehavioral Sciences (J.P.), Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles
| | - John Piacentini
- From the Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences (T.P., D.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Departments of Neurology and Neurosurgery (M.S.O.), Fixel Center for Neurological Diseases, University of Florida, Gainesville; Department of Psychiatry, Social Psychiatry, and Psychotherapy (K.M.-V.), Hannover Medical School, Germany; Department of Neurology (J.J.), Baylor College of Medicine, Houston, TX; Department of Neuropsychiatry (A.E.C.), BSMHFT, University of Birmingham and Aston University, UK; Department of Psychology (D.W.W.), Marquette University, Milwaukee, WI; Massachusetts Chapter (M.R.), Tourette Association of America, Bayside, NY; Waisman Center (E.J.), University Center for Excellence in Developmental Disabilities, University of Wisconsin, Madison; Technische Universitaet Dresden (V.R.), Germany; Departments of Pediatric and Neurology/Neurosurgery (M.O.), McGill University, Montréal, Canada; Department of Pediatrics (Neurology) (Y.H.-M.), Northwestern University Feinberg School of Medicine, Chicago, IL; and Department of Psychiatry and Biobehavioral Sciences (J.P.), Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles
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Essoe JKY, Grados MA, Singer HS, Myers NS, McGuire JF. Evidence-based treatment of Tourette's disorder and chronic tic disorders. Expert Rev Neurother 2019; 19:1103-1115. [PMID: 31295410 DOI: 10.1080/14737175.2019.1643236] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Introduction: Chronic Tic Disorders and Tourette's Disorder (collectively referred to as TD) are characterized by sudden, rapid, and repetitive motor movements or vocalizations called tics. Children, adolescents, and adults with TD often experience co-occurring psychiatric symptoms and impairments in multiple domains. As a result of tics and other symptoms, patients with TD can develop negative self-views, require considerable accommodations, and experience a poor quality of life. Therefore, the efficient and effective management of TD bears considerable importance. Areas covered: This expert review evaluated the empirical support for behavioral and pharmacological interventions based on the results of randomized controlled trials (RCTs). Behavioral interventions evaluated include habit reversal training (HRT), comprehensive behavioral intervention for tics (CBIT), and exposure response prevention (ERP). Reviewed pharmacological interventions included alpha-2 agonists, antipsychotics, and anticonvulsants. Expert opinion: This review identified several efficacious behavioral and pharmacological interventions for TD. However, several gaps in the management of TD include: (1) the access/availability of behavioral interventions, (2) novel and more efficacious treatment approaches, and (3) the development of more comprehensive interventions to manage TD. In order to advance the treatment of TD, additional research is necessary to efficiently, effectively, and comprehensively develop and evaluate new treatments for patients with TD.
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Affiliation(s)
- Joey Ka-Yee Essoe
- Division of Child and Adolescent Psychiatry, Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Marco A Grados
- Division of Child and Adolescent Psychiatry, Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Harvey S Singer
- Department of Neurology, Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Nicholas S Myers
- Division of Child and Adolescent Psychiatry, Johns Hopkins University School of Medicine , Baltimore , MD , USA.,Department of Psychology, Towson University , Towson , MD , USA
| | - Joseph F McGuire
- Division of Child and Adolescent Psychiatry, Johns Hopkins University School of Medicine , Baltimore , MD , USA
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29
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Viefhaus P, Feldhausen M, Görtz-Dorten A, Volk H, Döpfner M, Woitecki K. A new treatment for children with chronic tic disorders - Resource activation. Psychiatry Res 2019; 273:662-671. [PMID: 31207850 DOI: 10.1016/j.psychres.2019.01.083] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 01/24/2019] [Accepted: 01/25/2019] [Indexed: 11/15/2022]
Abstract
The aim of this pilot study is to evaluate the efficacy of a resource activation (RA) program as an alternative intervention for children and adolescents with tic disorders. RA interventions focus on the strengths and abilities of the patients. This is expected to improve the patients' perceptions regarding their own resources, which may indirectly result in a reduction of tic symptoms, impairment and comorbid conditions. A within-subject design with two phases (8 weeks diagnostic; 16 sessions treatment) was analyzed using multilevel modeling (n = 24). During the treatment phase, significant reductions of tics were found in clinical rating (Yale Global Tic Severity Scale; YGTSS), parent rating and video observation (motor tics). Moreover, an improvement was shown on most tic-related impairment and subjective burden (SB) ratings. No significant improvement was found regarding comorbid problems and self-esteem. Compared to the preceding diagnostic phase, a significant incremental treatment effect emerged in clinical rating of tic symptoms (YGTSS) and video observation (motor tics). This pilot study provides first hints that RA may represent an effective treatment for reducing tic symptoms, impairment and SB. However, further research is needed in order to establish RA as an effective treatment for tic disorders.
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Affiliation(s)
- Paula Viefhaus
- School of Child and Adolescent Cognitive Behavior Therapy (AKiP) at the University Hospital, Cologne, Pohligstr. 9, Köln D-50969, Germany.
| | - Marion Feldhausen
- School of Child and Adolescent Cognitive Behavior Therapy (AKiP) at the University Hospital, Cologne, Pohligstr. 9, Köln D-50969, Germany
| | - Anja Görtz-Dorten
- School of Child and Adolescent Cognitive Behavior Therapy (AKiP) at the University Hospital, Cologne, Pohligstr. 9, Köln D-50969, Germany; Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical Faculty of the University of Cologne, Robert-Koch-Str. 10, Cologne D-50931, Germany
| | - Helene Volk
- School of Child and Adolescent Cognitive Behavior Therapy (AKiP) at the University Hospital, Cologne, Pohligstr. 9, Köln D-50969, Germany
| | - Manfred Döpfner
- School of Child and Adolescent Cognitive Behavior Therapy (AKiP) at the University Hospital, Cologne, Pohligstr. 9, Köln D-50969, Germany; Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical Faculty of the University of Cologne, Robert-Koch-Str. 10, Cologne D-50931, Germany
| | - Katrin Woitecki
- School of Child and Adolescent Cognitive Behavior Therapy (AKiP) at the University Hospital, Cologne, Pohligstr. 9, Köln D-50969, Germany
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30
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Viefhaus P, Feldhausen M, Görtz-Dorten A, Volk H, Döpfner M, Woitecki K. Efficacy of Habit Reversal Training in Children With Chronic Tic Disorders: A Within-Subject Analysis. Behav Modif 2018; 44:114-136. [PMID: 30146896 DOI: 10.1177/0145445518796203] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The aim of this study is to evaluate a cognitive-behavioral treatment for children and adolescents with tic disorder including habit reversal training (HRT) in a sample of children and adolescents (n = 27). Multiple outcome measures were used to assess the effects of the treatment on tic symptoms. In addition, impairment/subjective burden ratings and the self-efficacy to control tics were assessed. A within-subject design with two phases (8 weeks diagnostic; 16 sessions treatment) was analyzed using multilevel modeling (MLM). During the treatment phase, significant improvements in tic symptoms, impairment, and self-efficacy to control tics were found on most outcome measures. Treatment effects were found on the clinical rating of tic symptoms (Yale Global Tic Severity Scale [YGTSS]), the self-efficacy to control tics, and the video-observed motor tic frequency by comparing the improvements during treatment with the course of the outcome measures during the preceding diagnostic phase.
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Affiliation(s)
- Paula Viefhaus
- School of Child and Adolescent Cognitive Behavior Therapy (AKiP), University Hospital, Cologne, Germany
| | - Marion Feldhausen
- School of Child and Adolescent Cognitive Behavior Therapy (AKiP), University Hospital, Cologne, Germany
| | - Anja Görtz-Dorten
- School of Child and Adolescent Cognitive Behavior Therapy (AKiP), University Hospital, Cologne, Germany.,Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Cologne, Germany
| | - Helene Volk
- School of Child and Adolescent Cognitive Behavior Therapy (AKiP), University Hospital, Cologne, Germany
| | - Manfred Döpfner
- School of Child and Adolescent Cognitive Behavior Therapy (AKiP), University Hospital, Cologne, Germany.,Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Cologne, Germany
| | - Katrin Woitecki
- School of Child and Adolescent Cognitive Behavior Therapy (AKiP), University Hospital, Cologne, Germany
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31
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Dabrowski J, King J, Edwards K, Yates R, Heyman I, Zimmerman-Brenner S, Murphy T. The Long-Term Effects of Group-Based Psychological Interventions for Children With Tourette Syndrome: A Randomized Controlled Trial. Behav Ther 2018; 49:331-343. [PMID: 29704964 DOI: 10.1016/j.beth.2017.10.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 09/28/2017] [Accepted: 10/25/2017] [Indexed: 10/18/2022]
Abstract
This randomized controlled trial examined the long-term effects of group-based psychological interventions on measures of tic severity, self-reported quality of life (QOL), and school attendance. Children (n = 28) with Tourette syndrome (TS) were assessed 12 months after completing a course of either group-based Habit Reversal Training (HRT) or Education. Both groups demonstrated long-term improvement in tic severity and QOL, which included significant continued improvement during the follow-up (FU) period. Both groups also showed significant posttreatment improvement in school attendance. Further research is required to explore potential therapeutic mechanisms, independent or mutual, which may underlie long-term symptom improvements.
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Affiliation(s)
| | | | | | | | - Isobel Heyman
- Great Ormond Street Hospital for Children NHS Foundation Trust; UCL Great Ormond Street Institute of Child Health
| | | | - Tara Murphy
- Great Ormond Street Hospital for Children NHS Foundation Trust; UCL Great Ormond Street Institute of Child Health.
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32
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McGuire JF, Piacentini J, Storch EA, Murphy TK, Ricketts EJ, Woods DW, Walkup JW, Peterson AL, Wilhelm S, Lewin AB, McCracken JT, Leckman JF, Scahill L. A multicenter examination and strategic revisions of the Yale Global Tic Severity Scale. Neurology 2018; 90:e1711-e1719. [PMID: 29653992 DOI: 10.1212/wnl.0000000000005474] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 02/16/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To examine the internal consistency and distribution of the Yale Global Tic Severity Scale (YGTSS) scores to inform modification of the measure. METHODS This cross-sectional study included 617 participants with a tic disorder (516 children and 101 adults), who completed an age-appropriate diagnostic interview and the YGTSS to evaluate tic symptom severity. The distributions of scores on YGTSS dimensions were evaluated for normality and skewness. For dimensions that were skewed across motor and phonic tics, a modified Delphi consensus process was used to revise selected anchor points. RESULTS Children and adults had similar clinical characteristics, including tic symptom severity. All participants were examined together. Strong internal consistency was identified for the YGTSS Motor Tic score (α = 0.80), YGTSS Phonic Tic score (α = 0.87), and YGTSS Total Tic score (α = 0.82). The YGTSS Total Tic and Impairment scores exhibited relatively normal distributions. Several subscales and individual item scales departed from a normal distribution. Higher scores were more often used on the Motor Tic Number, Frequency, and Intensity dimensions and the Phonic Tic Frequency dimension. By contrast, lower scores were more often used on Motor Tic Complexity and Interference, and Phonic Tic Number, Intensity, Complexity, and Interference. CONCLUSIONS The YGTSS exhibits good internal consistency across children and adults. The parallel findings across Motor and Phonic Frequency, Complexity, and Interference dimensions prompted minor revisions to the anchor point description to promote use of the full range of scores in each dimension. Specific minor revisions to the YGTSS Phonic Tic Symptom Checklist were also proposed.
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Affiliation(s)
- Joseph F McGuire
- From the Department of Psychiatry and Behavioral Sciences (J.F.M.), Johns Hopkins University School of Medicine, Baltimore, MD; Semel Institute of Neuroscience and Human Behavior (J.F.M., J.P., E.R., J.T.M.), University of California Los Angeles; Baylor College of Medicine (E.A.S.), Houston, TX; Departments of Pediatrics, Psychiatry and Behavioral Neuroscience (T.K.M., A.B.L.), University of South Florida, Tampa; All Children's Hospital (T.K.M.), Johns Hopkins Medicine, Baltimore, MD; Marquette University (D.W.W.), Milwaukee, WI; Weill Cornell Medical College (J.W.W.), Cornell University, New York, NY; Department of Psychiatry (A.L.P.), University of Texas Health Science Center at San Antonio; South Texas Veterans Health Care System (A.L.P.), San Antonio; Massachusetts General Hospital and Harvard Medical School (S.W.), Boston; Yale Child Study Center (J.F.L.), New Haven, CT; and Marcus Autism Center (L.S.), Emory University School of Medicine, Atlanta, GA.
| | - John Piacentini
- From the Department of Psychiatry and Behavioral Sciences (J.F.M.), Johns Hopkins University School of Medicine, Baltimore, MD; Semel Institute of Neuroscience and Human Behavior (J.F.M., J.P., E.R., J.T.M.), University of California Los Angeles; Baylor College of Medicine (E.A.S.), Houston, TX; Departments of Pediatrics, Psychiatry and Behavioral Neuroscience (T.K.M., A.B.L.), University of South Florida, Tampa; All Children's Hospital (T.K.M.), Johns Hopkins Medicine, Baltimore, MD; Marquette University (D.W.W.), Milwaukee, WI; Weill Cornell Medical College (J.W.W.), Cornell University, New York, NY; Department of Psychiatry (A.L.P.), University of Texas Health Science Center at San Antonio; South Texas Veterans Health Care System (A.L.P.), San Antonio; Massachusetts General Hospital and Harvard Medical School (S.W.), Boston; Yale Child Study Center (J.F.L.), New Haven, CT; and Marcus Autism Center (L.S.), Emory University School of Medicine, Atlanta, GA
| | - Eric A Storch
- From the Department of Psychiatry and Behavioral Sciences (J.F.M.), Johns Hopkins University School of Medicine, Baltimore, MD; Semel Institute of Neuroscience and Human Behavior (J.F.M., J.P., E.R., J.T.M.), University of California Los Angeles; Baylor College of Medicine (E.A.S.), Houston, TX; Departments of Pediatrics, Psychiatry and Behavioral Neuroscience (T.K.M., A.B.L.), University of South Florida, Tampa; All Children's Hospital (T.K.M.), Johns Hopkins Medicine, Baltimore, MD; Marquette University (D.W.W.), Milwaukee, WI; Weill Cornell Medical College (J.W.W.), Cornell University, New York, NY; Department of Psychiatry (A.L.P.), University of Texas Health Science Center at San Antonio; South Texas Veterans Health Care System (A.L.P.), San Antonio; Massachusetts General Hospital and Harvard Medical School (S.W.), Boston; Yale Child Study Center (J.F.L.), New Haven, CT; and Marcus Autism Center (L.S.), Emory University School of Medicine, Atlanta, GA
| | - Tanya K Murphy
- From the Department of Psychiatry and Behavioral Sciences (J.F.M.), Johns Hopkins University School of Medicine, Baltimore, MD; Semel Institute of Neuroscience and Human Behavior (J.F.M., J.P., E.R., J.T.M.), University of California Los Angeles; Baylor College of Medicine (E.A.S.), Houston, TX; Departments of Pediatrics, Psychiatry and Behavioral Neuroscience (T.K.M., A.B.L.), University of South Florida, Tampa; All Children's Hospital (T.K.M.), Johns Hopkins Medicine, Baltimore, MD; Marquette University (D.W.W.), Milwaukee, WI; Weill Cornell Medical College (J.W.W.), Cornell University, New York, NY; Department of Psychiatry (A.L.P.), University of Texas Health Science Center at San Antonio; South Texas Veterans Health Care System (A.L.P.), San Antonio; Massachusetts General Hospital and Harvard Medical School (S.W.), Boston; Yale Child Study Center (J.F.L.), New Haven, CT; and Marcus Autism Center (L.S.), Emory University School of Medicine, Atlanta, GA
| | - Emily J Ricketts
- From the Department of Psychiatry and Behavioral Sciences (J.F.M.), Johns Hopkins University School of Medicine, Baltimore, MD; Semel Institute of Neuroscience and Human Behavior (J.F.M., J.P., E.R., J.T.M.), University of California Los Angeles; Baylor College of Medicine (E.A.S.), Houston, TX; Departments of Pediatrics, Psychiatry and Behavioral Neuroscience (T.K.M., A.B.L.), University of South Florida, Tampa; All Children's Hospital (T.K.M.), Johns Hopkins Medicine, Baltimore, MD; Marquette University (D.W.W.), Milwaukee, WI; Weill Cornell Medical College (J.W.W.), Cornell University, New York, NY; Department of Psychiatry (A.L.P.), University of Texas Health Science Center at San Antonio; South Texas Veterans Health Care System (A.L.P.), San Antonio; Massachusetts General Hospital and Harvard Medical School (S.W.), Boston; Yale Child Study Center (J.F.L.), New Haven, CT; and Marcus Autism Center (L.S.), Emory University School of Medicine, Atlanta, GA
| | - Douglas W Woods
- From the Department of Psychiatry and Behavioral Sciences (J.F.M.), Johns Hopkins University School of Medicine, Baltimore, MD; Semel Institute of Neuroscience and Human Behavior (J.F.M., J.P., E.R., J.T.M.), University of California Los Angeles; Baylor College of Medicine (E.A.S.), Houston, TX; Departments of Pediatrics, Psychiatry and Behavioral Neuroscience (T.K.M., A.B.L.), University of South Florida, Tampa; All Children's Hospital (T.K.M.), Johns Hopkins Medicine, Baltimore, MD; Marquette University (D.W.W.), Milwaukee, WI; Weill Cornell Medical College (J.W.W.), Cornell University, New York, NY; Department of Psychiatry (A.L.P.), University of Texas Health Science Center at San Antonio; South Texas Veterans Health Care System (A.L.P.), San Antonio; Massachusetts General Hospital and Harvard Medical School (S.W.), Boston; Yale Child Study Center (J.F.L.), New Haven, CT; and Marcus Autism Center (L.S.), Emory University School of Medicine, Atlanta, GA
| | - John W Walkup
- From the Department of Psychiatry and Behavioral Sciences (J.F.M.), Johns Hopkins University School of Medicine, Baltimore, MD; Semel Institute of Neuroscience and Human Behavior (J.F.M., J.P., E.R., J.T.M.), University of California Los Angeles; Baylor College of Medicine (E.A.S.), Houston, TX; Departments of Pediatrics, Psychiatry and Behavioral Neuroscience (T.K.M., A.B.L.), University of South Florida, Tampa; All Children's Hospital (T.K.M.), Johns Hopkins Medicine, Baltimore, MD; Marquette University (D.W.W.), Milwaukee, WI; Weill Cornell Medical College (J.W.W.), Cornell University, New York, NY; Department of Psychiatry (A.L.P.), University of Texas Health Science Center at San Antonio; South Texas Veterans Health Care System (A.L.P.), San Antonio; Massachusetts General Hospital and Harvard Medical School (S.W.), Boston; Yale Child Study Center (J.F.L.), New Haven, CT; and Marcus Autism Center (L.S.), Emory University School of Medicine, Atlanta, GA
| | - Alan L Peterson
- From the Department of Psychiatry and Behavioral Sciences (J.F.M.), Johns Hopkins University School of Medicine, Baltimore, MD; Semel Institute of Neuroscience and Human Behavior (J.F.M., J.P., E.R., J.T.M.), University of California Los Angeles; Baylor College of Medicine (E.A.S.), Houston, TX; Departments of Pediatrics, Psychiatry and Behavioral Neuroscience (T.K.M., A.B.L.), University of South Florida, Tampa; All Children's Hospital (T.K.M.), Johns Hopkins Medicine, Baltimore, MD; Marquette University (D.W.W.), Milwaukee, WI; Weill Cornell Medical College (J.W.W.), Cornell University, New York, NY; Department of Psychiatry (A.L.P.), University of Texas Health Science Center at San Antonio; South Texas Veterans Health Care System (A.L.P.), San Antonio; Massachusetts General Hospital and Harvard Medical School (S.W.), Boston; Yale Child Study Center (J.F.L.), New Haven, CT; and Marcus Autism Center (L.S.), Emory University School of Medicine, Atlanta, GA
| | - Sabine Wilhelm
- From the Department of Psychiatry and Behavioral Sciences (J.F.M.), Johns Hopkins University School of Medicine, Baltimore, MD; Semel Institute of Neuroscience and Human Behavior (J.F.M., J.P., E.R., J.T.M.), University of California Los Angeles; Baylor College of Medicine (E.A.S.), Houston, TX; Departments of Pediatrics, Psychiatry and Behavioral Neuroscience (T.K.M., A.B.L.), University of South Florida, Tampa; All Children's Hospital (T.K.M.), Johns Hopkins Medicine, Baltimore, MD; Marquette University (D.W.W.), Milwaukee, WI; Weill Cornell Medical College (J.W.W.), Cornell University, New York, NY; Department of Psychiatry (A.L.P.), University of Texas Health Science Center at San Antonio; South Texas Veterans Health Care System (A.L.P.), San Antonio; Massachusetts General Hospital and Harvard Medical School (S.W.), Boston; Yale Child Study Center (J.F.L.), New Haven, CT; and Marcus Autism Center (L.S.), Emory University School of Medicine, Atlanta, GA
| | - Adam B Lewin
- From the Department of Psychiatry and Behavioral Sciences (J.F.M.), Johns Hopkins University School of Medicine, Baltimore, MD; Semel Institute of Neuroscience and Human Behavior (J.F.M., J.P., E.R., J.T.M.), University of California Los Angeles; Baylor College of Medicine (E.A.S.), Houston, TX; Departments of Pediatrics, Psychiatry and Behavioral Neuroscience (T.K.M., A.B.L.), University of South Florida, Tampa; All Children's Hospital (T.K.M.), Johns Hopkins Medicine, Baltimore, MD; Marquette University (D.W.W.), Milwaukee, WI; Weill Cornell Medical College (J.W.W.), Cornell University, New York, NY; Department of Psychiatry (A.L.P.), University of Texas Health Science Center at San Antonio; South Texas Veterans Health Care System (A.L.P.), San Antonio; Massachusetts General Hospital and Harvard Medical School (S.W.), Boston; Yale Child Study Center (J.F.L.), New Haven, CT; and Marcus Autism Center (L.S.), Emory University School of Medicine, Atlanta, GA
| | - James T McCracken
- From the Department of Psychiatry and Behavioral Sciences (J.F.M.), Johns Hopkins University School of Medicine, Baltimore, MD; Semel Institute of Neuroscience and Human Behavior (J.F.M., J.P., E.R., J.T.M.), University of California Los Angeles; Baylor College of Medicine (E.A.S.), Houston, TX; Departments of Pediatrics, Psychiatry and Behavioral Neuroscience (T.K.M., A.B.L.), University of South Florida, Tampa; All Children's Hospital (T.K.M.), Johns Hopkins Medicine, Baltimore, MD; Marquette University (D.W.W.), Milwaukee, WI; Weill Cornell Medical College (J.W.W.), Cornell University, New York, NY; Department of Psychiatry (A.L.P.), University of Texas Health Science Center at San Antonio; South Texas Veterans Health Care System (A.L.P.), San Antonio; Massachusetts General Hospital and Harvard Medical School (S.W.), Boston; Yale Child Study Center (J.F.L.), New Haven, CT; and Marcus Autism Center (L.S.), Emory University School of Medicine, Atlanta, GA
| | - James F Leckman
- From the Department of Psychiatry and Behavioral Sciences (J.F.M.), Johns Hopkins University School of Medicine, Baltimore, MD; Semel Institute of Neuroscience and Human Behavior (J.F.M., J.P., E.R., J.T.M.), University of California Los Angeles; Baylor College of Medicine (E.A.S.), Houston, TX; Departments of Pediatrics, Psychiatry and Behavioral Neuroscience (T.K.M., A.B.L.), University of South Florida, Tampa; All Children's Hospital (T.K.M.), Johns Hopkins Medicine, Baltimore, MD; Marquette University (D.W.W.), Milwaukee, WI; Weill Cornell Medical College (J.W.W.), Cornell University, New York, NY; Department of Psychiatry (A.L.P.), University of Texas Health Science Center at San Antonio; South Texas Veterans Health Care System (A.L.P.), San Antonio; Massachusetts General Hospital and Harvard Medical School (S.W.), Boston; Yale Child Study Center (J.F.L.), New Haven, CT; and Marcus Autism Center (L.S.), Emory University School of Medicine, Atlanta, GA
| | - Lawrence Scahill
- From the Department of Psychiatry and Behavioral Sciences (J.F.M.), Johns Hopkins University School of Medicine, Baltimore, MD; Semel Institute of Neuroscience and Human Behavior (J.F.M., J.P., E.R., J.T.M.), University of California Los Angeles; Baylor College of Medicine (E.A.S.), Houston, TX; Departments of Pediatrics, Psychiatry and Behavioral Neuroscience (T.K.M., A.B.L.), University of South Florida, Tampa; All Children's Hospital (T.K.M.), Johns Hopkins Medicine, Baltimore, MD; Marquette University (D.W.W.), Milwaukee, WI; Weill Cornell Medical College (J.W.W.), Cornell University, New York, NY; Department of Psychiatry (A.L.P.), University of Texas Health Science Center at San Antonio; South Texas Veterans Health Care System (A.L.P.), San Antonio; Massachusetts General Hospital and Harvard Medical School (S.W.), Boston; Yale Child Study Center (J.F.L.), New Haven, CT; and Marcus Autism Center (L.S.), Emory University School of Medicine, Atlanta, GA
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Storch EA, Small BJ, McGuire JF, Murphy TK, Wilhelm S, Geller DA. Quality of Life in Children and Youth with Obsessive-Compulsive Disorder. J Child Adolesc Psychopharmacol 2018; 28:104-110. [PMID: 28910139 PMCID: PMC5831750 DOI: 10.1089/cap.2017.0091] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The study examined clinical correlates of quality of life (QoL), impact of treatment on QoL, and predictors of QoL change among children with obsessive-compulsive disorder (OCD). METHODS One hundred forty-two children with primary OCD who were enrolled as part of a larger clinical trial participated. Children were administered a structured diagnostic interview, as well as clinician-administered measures of OCD and depression symptom severity. Children and parents completed reports of QoL, as well as measures of impairment and internalizing and externalizing symptoms. Youth received 10 sessions of family-based cognitive-behavioral therapy (CBT). RESULTS At baseline, QoL was inversely related to obsessive-compulsive symptom severity, impairment, externalizing and internalizing symptoms, and severity of depression symptoms according to children and parents. After CBT, QoL improved according to parent ratings, but not child ratings. None of the predictors examined were associated with changes in QoL scores over time. Impairment, and externalizing and internalizing symptoms predicted QoL after accounting for OCD symptom severity. After accounting for OCD symptoms, externalizing symptoms inversely predicted changes in QoL. CONCLUSION These data suggest that QoL is related to more severe clinical presentation and improves with evidence-based treatment, but QoL improvements may be inversely related to externalizing symptomology.
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Affiliation(s)
- Eric A. Storch
- Department of Pediatrics, University of South Florida, St. Petersburg, Florida
- Department of Health Policy and Management, University of South Florida, St. Petersburg, Florida
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, St. Petersburg, Florida
- Rogers Memorial Hospital, Tampa, Florida
- Mind Body Branch, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | - Brent J. Small
- School of Aging Studies, University of South Florida, St. Petersburg, Florida
| | - Joseph F. McGuire
- Department of Psychiatry, The Johns Hopkins University, Baltimore, Maryland
| | - Tanya K. Murphy
- Department of Pediatrics, University of South Florida, St. Petersburg, Florida
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, St. Petersburg, Florida
- Mind Body Branch, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | - Sabine Wilhelm
- Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts
| | - Daniel A. Geller
- Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts
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Pringsheim T. Tic Severity and Treatment in Children: The Effect of Comorbid Attention Deficit Hyperactivity Disorder and Obsessive Compulsive Behaviors. Child Psychiatry Hum Dev 2017; 48:960-966. [PMID: 28289952 DOI: 10.1007/s10578-017-0718-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
While attention deficit hyperactivity disorder (ADHD) and obsessive compulsive disorder have been shown to have major impacts on quality of life in individuals with Tourette syndrome, there is comparatively little data on how the presence of these comorbidities influence tic severity and treatment. 114 children (mean age 10.25 years) were extensively clinically phenotyped at a single specialty clinic. While there was no difference in Yale Global Tic Severity Scale (YGTSS) scores in children with versus without ADHD, children with obsessive compulsive behaviors had significantly higher YGTSS scores (p = 0.008). There was a significant correlation between YGTSS scores and age (r = 0.344, p < 0.001). Children with ADHD were more likely to be treated for their tics within the first two years of diagnosis (OR 3.51, p = 0.009). As tic severity does not appear to be greater in children with ADHD, this association may relate to greater overall psychosocial impairment in children with this comorbidity.
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Affiliation(s)
- Tamara Pringsheim
- Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences, Mathison Centre for Mental Health Research and Education, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada.
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McGuire JF, Ginder N. Behavior Therapy for Tics and Tic Disorders. Psychiatr Ann 2017. [DOI: 10.3928/00485713-20171026-01] [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: 11/20/2022]
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A preliminary examination of self-concept in older adolescents and young adults with Gilles de la Tourette syndrome. Eur J Paediatr Neurol 2017; 21:468-474. [PMID: 28017555 DOI: 10.1016/j.ejpn.2016.12.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 12/05/2016] [Accepted: 12/11/2016] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Gilles de la Tourette syndrome (GTS) is a childhood-onset neuropsychiatric disorder characterised by multiple tics and often associated with behavioural problems. Although there is evidence of significantly reduced self-esteem in children and adolescents with GTS, little is known about perceived self-concept and its clinical determinants at the transition age between adolescence and adulthood. We therefore set out to investigate self-concept in a clinical sample of young patients with GTS at this crucial age for personal development. METHODS In addition to standard demographic and clinical data, we collected self-ratings using a standardised battery of psychometric instruments, as well as the Multidimensional Self Concept Scale, a comprehensive questionnaire developed to assess self-concept in subjects aged 9- to 19 years, tapping into the social, competence, affect, academic, family, and physical domains. RESULTS We found that patients diagnosed with at least one co-morbid psychiatric disorder ("GTS-plus" phenotype) reported significantly lower self-concept than patients with "pure GTS", whereas tic-related variables had no impact on self-concept. Anxiety symptoms were the main determinants of self-concept, especially trait anxiety with regard to social and affective domains. Affective symptoms could also have a negative impact on the physical, affective, competence, and social domains of self-concept. CONCLUSION Routine screening for anxiety and affective symptoms should be recommended in all patients with GTS seen at transition clinics from paediatric to adult care, in order to implement effective treatment interventions whenever possible.
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Robertson MM, Eapen V. The Psychosocial Aspects of the Gilles de la Tourette Syndrome: Empirical Evidence from the Literature. Curr Behav Neurosci Rep 2017. [DOI: 10.1007/s40473-017-0107-8] [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: 10/20/2022]
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Conelea CA, Wellen BCM. Tic Treatment Goes Tech: A Review of TicHelper.com. COGNITIVE AND BEHAVIORAL PRACTICE 2017; 24:374-381. [PMID: 28966546 DOI: 10.1016/j.cbpra.2017.01.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
TicHelper.com ("TicHelper") is an interactive online treatment program for youth with chronic tic disorders (CTDs) or Tourette Syndrome (TS) and their parents. It is based on Comprehensive Behavioral Intervention for Tics (CBIT), an individual, outpatient therapy protocol shown to effectively reduce tics in randomized controlled trials. The TicHelper website offers a user-friendly dashboard that is effective in making it easy to navigate through different treatment modules. Modules parallel core CBIT procedures and consist of interactive exercises, informational videos, and self-report ratings. TicHelper has some weaknesses (e.g., no outcomes research specific to the program has been published to date); however, its strengths (easily navigable, clear instructions, appropriate content) outweigh its weaknesses, making it a potentially useful dissemination tool to make CBIT more accessible to families and youth with tics.
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Abstract
Persistent tic disorders and Tourette disorder (TD) are neuropsychiatric conditions that commonly co-occur among youth with obsessive-compulsive disorder. Although historically managed with pharmacological agents such as antipsychotics and alpha-2 agonists, behavioral interventions like habit reversal training (HRT) and the comprehensive behavioral intervention for tics have demonstrated considerable efficacy in reducing tic symptom severity. This case study illustrates the implementation of behavior therapy in reducing tic symptom severity of an adolescent with TD. Arlene was a 14-year-old girl with TD who presented with moderate tic symptom severity that caused her physical, academic, and social impairment. In addition to concurrent pharmacotherapy, Arlene completed a 20-session weekly course of HRT, and experienced a clinically meaningful reduction in tic symptom severity and tic-related impairment. This example provides further evidence of the benefit of behavior therapy in reducing tic symptom severity and highlights key considerations for treatment of youth with TD.
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Affiliation(s)
- Joseph F McGuire
- Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles.
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Gilles de la Tourette syndrome – A treatable condition? Rev Neurol (Paris) 2016; 172:446-454. [DOI: 10.1016/j.neurol.2016.07.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 07/08/2016] [Indexed: 01/25/2023]
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Johnco C, McGuire JF, McBride NM, Murphy TK, Lewin AB, Storch EA. Suicidal ideation in youth with tic disorders. J Affect Disord 2016; 200:204-11. [PMID: 27136419 PMCID: PMC4887311 DOI: 10.1016/j.jad.2016.04.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 04/16/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND This study examined the incidence and clinical correlates of suicidal ideation (SI) in youth with tic disorders (TD). The independent contribution of tics, anxiety, depressive and externalizing symptoms on SI severity in youth with TD was assessed. METHOD Participants were 75 treatment-seeking youth with a TD (N=75) aged 6-18. Participants completed diagnostic assessments, clinician-ratings, self- and parent-report measures of emotional functioning and the presence and/or severity of suicidal ideation. RESULTS Based on youth-report, 61% of youth endorsed at least some symptoms of SI, and 8% endorsed symptoms that exceeded the clinically significant cut-off. Parents reported SI in 11% of cases, with generally poor agreement between parent- and youth-report. Suicidal ideation correlated with higher anxiety, depressive and externalizing symptoms, affective lability, and with poorer distress tolerance and overall functioning. Anxiety, depressive and externalizing symptoms showed an independent relationship with SI. Tic severity was not associated with SI. Rather, higher tic severity was associated with an increase in anxiety symptoms, which in turn, was associated with greater SI severity. LIMITATIONS Cross-sectional data limits causal conclusions. Diagnosis was based on unstructured assessments by expert clinicians, including consensus diagnosis, rather than structured clinical interviews. CONCLUSIONS Around 8-11% of youth with TD experienced SI. Tic severity did not have any direct influence on SI, however the presence of comorbid anxiety and depressive symptoms significantly increases this risk. Results suggest that it is psychiatric comorbidity, rather than tics themselves, that predispose youth with tic disorders to increased risk of suicidality.
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Affiliation(s)
- Carly Johnco
- Department of Pediatrics, University of South Florida, USA; Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia.
| | - Joseph F McGuire
- Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, USA
| | | | - Tanya K Murphy
- Department of Pediatrics, University of South Florida, USA; Department of Psychiatry & Behavioral Neurosciences, University of South Florida, USA; All Children's Hospital - Johns Hopkins Medicine, St Petersburg, FL, USA
| | - Adam B Lewin
- Department of Pediatrics, University of South Florida, USA; Department of Psychiatry & Behavioral Neurosciences, University of South Florida, USA; Department of Psychology, University of South Florida, USA
| | - Eric A Storch
- Department of Pediatrics, University of South Florida, USA; Department of Psychiatry & Behavioral Neurosciences, University of South Florida, USA; All Children's Hospital - Johns Hopkins Medicine, St Petersburg, FL, USA; Department of Psychology, University of South Florida, USA; Department of Health Policy and Management, University of South Florida, USA; Rogers Behavioral Health - Tampa Bay, Tampa, FL, USA
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Abstract
We present selected highlights from research that appeared during 2015 on Tourette syndrome and other tic disorders. Topics include phenomenology, comorbidities, developmental course, genetics, animal models, neuroimaging, electrophysiology, pharmacology, and treatment. We briefly summarize articles whose results we believe may lead to new treatments, additional research or modifications in current models of TS.
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Affiliation(s)
- Cheryl A Richards
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA; Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Kevin J Black
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA; Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA; Department of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA; Department of Neuroscience, Washington University School of Medicine, St. Louis, Missouri, USA
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McGuire JF, Piacentini J, Lewin AB, Murphy TK, Storch EA. Further evidence of behavioral interventions for tic disorders: A reply to Theule and colleagues. J Psychiatr Res 2016; 74:35-7. [PMID: 26736039 PMCID: PMC4744493 DOI: 10.1016/j.jpsychires.2015.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 12/10/2015] [Indexed: 12/26/2022]
Abstract
We were delighted to read the letter by Dr. Theule and colleagues (Theule et al., 2016) commenting on our meta-analysis of behavior therapy for Tourette Syndrome (TS)(McGuire et al., 2014). We welcome this discussion, and were interested to learn of their related meta-analysis on psychosocial treatments for tic disorders. This commentary addresses the similarities and distinctions between these two meta-analytic investigations, and concludes with recommendations regarding the future of treatment research for TS.
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Affiliation(s)
- Joseph F McGuire
- Semel Institute of Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, USA.
| | - John Piacentini
- Semel Institute of Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, USA
| | - Adam B Lewin
- Department of Pediatrics, University of South Florida, Tampa, FL, USA; Departments of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL, USA; All Children's Hospital, Johns Hopkins Medicine, St. Petersburg, FL, USA
| | - Tanya K Murphy
- Department of Pediatrics, University of South Florida, Tampa, FL, USA; Departments of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL, USA; All Children's Hospital, Johns Hopkins Medicine, St. Petersburg, FL, USA
| | - Eric A Storch
- Department of Pediatrics, University of South Florida, Tampa, FL, USA; Departments of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL, USA; All Children's Hospital, Johns Hopkins Medicine, St. Petersburg, FL, USA; Rogers Behavioral Health-Tampa Bay, Tampa, FL, USA; Department of Health Policy and Management, University of South Florida, Tampa, FL, USA
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44
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Hanks CE, McGuire JF, Lewin AB, Storch EA, Murphy TK. Clinical Correlates and Mediators of Self-Concept in Youth with Chronic Tic Disorders. Child Psychiatry Hum Dev 2016; 47:64-74. [PMID: 25791488 PMCID: PMC4575820 DOI: 10.1007/s10578-015-0544-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
This study investigated the clinical correlates and mediators of self-concept in youth with Chronic Tic Disorders (CTD). Ninety-seven youth aged 6-17 (M = 11.1 ± 2.89; 79.4 % male) with CTD were administered the Yale Global Tic Severity Scale, the Piers-Harris Children's Self-Concept Scale-Second Edition, and self-report and clinician-administered measures assessing behavioral and psychological difficulties and comorbid conditions. Youth with CTD had a slightly below average level of self-concept, with 20 % (n = 19) exhibiting low self-concept. Youth with CTD-only had greater self-concept relative to youth with CTD and obsessive-compulsive disorder (OCD) (p = 0.04) or CTD, OCD, and attention deficit hyperactivity disorder (ADHD) combined (p = 0.009). Medium-to-large-sized associations were observed between youth's self-concept and clinical characteristics (e.g., severity of ADHD, OCD and depressive symptoms). Youth's self-concept partially mediated the relationship between tic severity and depressive symptom severity, and the interaction between tic impairment and youth's reliance on avoidant coping strategies moderated youth's self-concept. Implications, limitations, and recommendations for future interventions are discussed.
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Affiliation(s)
- Camille E. Hanks
- Department of Pediatrics, University of South Florida, 880 6th Street South, Suite 460, Box 7523, St. Petersburg, FL 33701, USA
| | - Joseph F. McGuire
- Department of Pediatrics, University of South Florida, 880 6th Street South, Suite 460, Box 7523, St. Petersburg, FL 33701, USA,Department of Psychology, University of South Florida, St. Petersburg, FL, USA
| | - Adam B. Lewin
- Department of Pediatrics, University of South Florida, 880 6th Street South, Suite 460, Box 7523, St. Petersburg, FL 33701, USA,Department of Psychology, University of South Florida, St. Petersburg, FL, USA,Departments of Psychiatry and Behavioral Neurosciences, University of South Florida, St. Petersburg, FL, USA
| | - Eric A. Storch
- Department of Pediatrics, University of South Florida, 880 6th Street South, Suite 460, Box 7523, St. Petersburg, FL 33701, USA,Department of Psychology, University of South Florida, St. Petersburg, FL, USA,Departments of Psychiatry and Behavioral Neurosciences, University of South Florida, St. Petersburg, FL, USA,Rogers Behavioral Health – Tampa Bay, Tampa, FL, USA,All Children’s Hospital – Johns Hopkins Medicine, St. Petersburg, FL, USA,Department of Health Policy and Management, University of South Florida, Tampa, FL, USA
| | - Tanya K. Murphy
- Department of Pediatrics, University of South Florida, 880 6th Street South, Suite 460, Box 7523, St. Petersburg, FL 33701, USA,Departments of Psychiatry and Behavioral Neurosciences, University of South Florida, St. Petersburg, FL, USA,All Children’s Hospital – Johns Hopkins Medicine, St. Petersburg, FL, USA
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45
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Evans J, Seri S, Cavanna AE. The effects of Gilles de la Tourette syndrome and other chronic tic disorders on quality of life across the lifespan: a systematic review. Eur Child Adolesc Psychiatry 2016; 25:939-48. [PMID: 26880181 PMCID: PMC4990617 DOI: 10.1007/s00787-016-0823-8] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Accepted: 01/19/2016] [Indexed: 01/30/2023]
Abstract
Gilles de la Tourette syndrome (GTS) and other chronic tic disorders are neurodevelopmental conditions characterized by the presence of tics and associated behavioral problems. Whilst converging evidence indicates that these conditions can affect patients' quality of life (QoL), the extent of this impairment across the lifespan is not well understood. We conducted a systematic literature review of published QoL studies in GTS and other chronic tic disorders to comprehensively assess the effects of these conditions on QoL in different age groups. We found that QoL can be perceived differently by child and adult patients, especially with regard to the reciprocal contributions of tics and behavioral problems to the different domains of QoL. Specifically, QoL profiles in children often reflect the impact of co-morbid attention-deficit and hyperactivity symptoms, which tend to improve with age, whereas adults' perception of QoL seems to be more strongly affected by the presence of depression and anxiety. Management strategies should take into account differences in age-related QoL needs between children and adults with GTS or other chronic tic disorders.
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Affiliation(s)
- Joel Evans
- Department of Neuropsychiatry, BSMHFT and University of Birmingham Medical School, Birmingham, UK
| | - Stefano Seri
- School of Life and Health Sciences, Aston University, Birmingham, UK
| | - Andrea E. Cavanna
- Department of Neuropsychiatry, BSMHFT and University of Birmingham Medical School, Birmingham, UK ,School of Life and Health Sciences, Aston University, Birmingham, UK ,Sobell Department of Motor Neuroscience and Movement Disorders, UCL and Institute of Neurology, London, UK
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46
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McGuire JF, Ricketts EJ, Piacentini J, Murphy TK, Storch EA, Lewin AB. Behavior Therapy for Tic Disorders: An Evidenced-based Review and New Directions for Treatment Research. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2015; 2:309-317. [PMID: 26543797 PMCID: PMC4629635 DOI: 10.1007/s40474-015-0063-5] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Behavior therapy is an evidenced-based intervention with moderate-to-large treatment effects in reducing tic symptom severity among individuals with Persistent Tic Disorders (PTDs) and Tourette's Disorder (TD). This review describes the behavioral treatment model for tics, delineates components of evidence-based behavior therapy for tics, and reviews the empirical support among randomized controlled trials for individuals with PTDs or TD. Additionally, this review discusses several challenges confronting the behavioral management of tics, highlights emerging solutions for these challenges, and outlines new directions for treatment research.
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Affiliation(s)
- Joseph F. McGuire
- Semel Institute of Neuroscience and Human Behavior, University of California Los Angeles
| | - Emily J. Ricketts
- Semel Institute of Neuroscience and Human Behavior, University of California Los Angeles
| | - John Piacentini
- Semel Institute of Neuroscience and Human Behavior, University of California Los Angeles
| | - Tanya K. Murphy
- Department of Pediatrics, University of South Florida
- Departments of Psychiatry and Behavioral Neurosciences, University of South Florida
- All Children’s Hospital, Johns Hopkins Medicine, St. Petersburg, FL
| | - Eric A. Storch
- Department of Pediatrics, University of South Florida
- Departments of Psychiatry and Behavioral Neurosciences, University of South Florida
- Department of Health Policy and Management, University of South Florida
- Department of Psychology, University of South Florida
- Rogers Behavioral Health – Tampa Bay
- All Children’s Hospital, Johns Hopkins Medicine, St. Petersburg, FL
| | - Adam B. Lewin
- Department of Pediatrics, University of South Florida
- Departments of Psychiatry and Behavioral Neurosciences, University of South Florida
- Department of Psychology, University of South Florida
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47
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Evans GAL, Wittkowski A, Butler H, Hedderly T, Bunton P. Parenting Interventions for Children with Tic Disorders: Professionals' Perspectives. JOURNAL OF CHILD AND FAMILY STUDIES 2015; 25:1594-1604. [PMID: 27110085 PMCID: PMC4824798 DOI: 10.1007/s10826-015-0317-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Tic disorders can have an emotional and social impact on children and families, which can in turn have a reciprocal impact on tics. Research into parenting interventions within this population is limited. Twenty-five professionals' views on the acceptability, effectiveness, feasibility and utility of parenting interventions were explored using Q-methodology. Three highly correlated factors emerged, indicating three viewpoints with discrete elements that were underpinned by similar general perspectives. All factors endorsed a psychological approach, the importance of parenting practices, and theoretical and clinical justifications for parenting interventions. Discrete elements of the viewpoints debated the advocated focus, barriers and audience of interventions. Multidisciplinary professionals endorsed parenting interventions as a therapeutic tool within tic disorders. Results provide suggestions to further develop and implement interventions.
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Affiliation(s)
- Gemma A. L. Evans
- />School of Psychological Sciences, University of Manchester, 2nd Floor Zochonis Building, Manchester, M13 9PL UK
| | - Anja Wittkowski
- />School of Psychological Sciences, University of Manchester, 2nd Floor Zochonis Building, Manchester, M13 9PL UK
| | - Hannah Butler
- />School of Psychological Sciences, University of Manchester, 2nd Floor Zochonis Building, Manchester, M13 9PL UK
| | - Tammy Hedderly
- />Evelina London Children’s Hospital, St Thomas’ Hospital, London, SE1 7EH UK
| | - Penny Bunton
- />School of Psychological Sciences, University of Manchester, 2nd Floor Zochonis Building, Manchester, M13 9PL UK
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Obsessive-compulsive symptoms in children and adolescents: symptomatology, impairment and quality of life. Eur Child Adolesc Psychiatry 2015; 24:1389-98. [PMID: 25672655 DOI: 10.1007/s00787-015-0691-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 01/31/2015] [Indexed: 10/24/2022]
Abstract
Although the "presence of obsessive-compulsive (OC) symptoms" and "OC-related impairment" are the main criteria to diagnose obsessive-compulsive disorder, the significance of symptomatology versus impairment in explaining quality of life remains unclear. The present study relies on two samples including 462 children (8-11 years old) and 265 children and adolescents (10-17 years old) and explores how self-ratings of specific OC symptoms and OC impairment are associated with father ratings of childhood quality of life. Hierarchical regression analysis was used to investigate the additive effect of OC impairment beyond OC symptomatology (and vice versa) in predicting quality of life. The results demonstrated that specific OC symptoms and OC impairment are differentially related to quality of life, underscoring the additive value of OC impairment beyond OC symptomatology, whereas the reverse was not the case. This finding highlights the importance of measuring impairment besides symptomatology to identify those OC features in childhood that are most significantly related to decreased quality of life.
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49
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Hanks CE, Lewin AB, Mutch PJ, Storch EA, Murphy TK. Social Deficits and Autism Spectrum Disorders in Tourette’s Syndrome. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2015. [DOI: 10.1007/s40474-015-0060-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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