1
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Barber KE, Ding Q, Espil FM, Woods DW, Specht MW, Bennett SM, Stiede JT, Walkup JT, Ricketts EJ, McGuire JF, Peterson AL, Compton SN, Wilhelm S, Scahill L, Piacentini JC. Contextual Triggers and Tic Severity Across Life Periods: A Retrospective Analysis in Adults with Tic Disorders. Child Psychiatry Hum Dev 2024:10.1007/s10578-024-01733-y. [PMID: 38976153 DOI: 10.1007/s10578-024-01733-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/18/2024] [Indexed: 07/09/2024]
Abstract
In tic disorders (TD), tic expression varies across the lifespan and as a function of contextual factors. This study explored connections between tic expression and contextual triggers across life periods in 74 adults (Mage = 23.2) with TDs. The Tic History and Coping Strategies form assessed retrospective self-reports of contextual antecedents, consequences, and tic severity during four life periods (middle school; 9th/10th grade; 11th/12th grade; college/work) and past month. Tics reportedly worsened during and after school in school-aged years and worsened in the evening during college/work years. Stress and anxiety were reported to consistently trigger tics across time. The impact of activities, places, and emotions did not differ across life periods. Attention-based consequences, most prevalent during middle school, were more common than escape- or avoidance-related consequences across all periods. Findings illuminate how contextual factors may influence tics across life periods and underscore the consistent impact of tic-triggering emotions and attention-related consequences.
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Affiliation(s)
- Kathryn E Barber
- Department of Psychology, Marquette University, Milwaukee, WI, USA
| | - Qiang Ding
- Department of Psychological Medicine, Children's Hospital of Fudan University Shanghai, Shanghai, PR China
| | - Flint M Espil
- Department of Psychiatry, Stanford University, Stanford, CA, USA
| | - Douglas W Woods
- Department of Psychology, Marquette University, Milwaukee, WI, USA.
- Department of Psychology, Loyola University of Chicago, Chicago, IL, USA.
| | - Matthew W Specht
- Connecticut OCD, Anxiety, and Tic Specialists, Greenwich, CT, USA
| | | | | | - John T Walkup
- Department of Psychiatry and Behavioral Health, Lurie Children's, Chicago, IL, USA
| | - Emily J Ricketts
- Department of Neuroscience, UCLA Semel Institute, Los Angeles, CA, USA
| | - Joseph F McGuire
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Alan L Peterson
- Department of Psychiatry & Behavioral Sciences, University of Texas San Antonio, San Antonio, TX, USA
| | - Scott N Compton
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Sabine Wilhelm
- Harvard University School of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | | | - John C Piacentini
- Department of Child & Adolescent Psychiatry, UCLA Semel Institute, Los Angeles, CA, USA
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2
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Woods DW, Himle MB, Stiede JT, Pitts BX. Behavioral Interventions for Children and Adults with Tic Disorder. Annu Rev Clin Psychol 2023; 19:233-260. [PMID: 37159286 DOI: 10.1146/annurev-clinpsy-080921-074307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Over the past decade, behavioral interventions have become increasingly recognized and recommended as effective first-line therapies for treating individuals with tic disorders. In this article, we describe a basic theoretical and conceptual framework through which the reader can understand the application of these interventions for treating tics. The three primary behavioral interventions for tics with the strongest empirical support (habit reversal, Comprehensive Behavioral Intervention for Tics, and exposure and response prevention) are described. Research on the efficacy and effectiveness of these treatments is summarized along with a discussion of the research evaluating the delivery of these treatments in different formats and modalities. The article closes with a review of the possible mechanisms of change underlying behavioral interventions for tics and areas for future research.
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Affiliation(s)
- Douglas W Woods
- Department of Psychology, Marquette University, Milwaukee, Wisconsin, USA;
| | - Michael B Himle
- Department of Psychology, University of Utah, Salt Lake City, Utah, USA
| | - Jordan T Stiede
- Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - Brandon X Pitts
- Department of Psychology, Marquette University, Milwaukee, Wisconsin, USA;
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3
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Schütteler C, Gerlach AL. Die Bedeutung des Vorgefühls bei Tic-Störungen. ZEITSCHRIFT FUR KLINISCHE PSYCHOLOGIE UND PSYCHOTHERAPIE 2022. [DOI: 10.1026/1616-3443/a000677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Zusammenfassung. Theoretischer Hintergrund: Die Funktion des Vorgefühls in der Pathogenese und Aufrechterhaltung von Tic-Störungen (TS) wird in den letzten Jahren verstärkt erforscht. Die mögliche funktionelle Bedeutung der Vorgefühle wird aber noch nicht ausreichend verstanden. Methode: Im vorliegenden Review wird der Kenntnisstand zu Vorgefühlen entlang eines integrativen funktionalen Störungsmodells zusammengefasst. Ergebnisse: Im Vergleich zum Jugendalter nehmen Tic-Symptome bei Tic-Störungen im Erwachsenenalter ab, während immer mehr Betroffene ein Vorgefühl berichten. Hierbei kann zwischen einem allgemeinen Vorgefühl (trait) und dem Drang, Tics auszuführen (state) unterschieden werden. Das Vorgefühl als trait ist abhängig von der Interozeptionsfähigkeit. An den Drang, Tics auszuführen, kann habituiert werden, moderiert von Aufmerksamkeits- und Attributionsprozessen. Durch das Auflösen des Vorgefühl-Tic-Reizreaktionsmusters reduzieren sich die Tic-Symptome. Schlussfolgerung: Für weitere Erkenntnisse in Bezug auf die Bedeutung von Vorgefühl und den Drang, Tics auszuführen, sollten zukünftige Forschungsansätze Drang und allgemeine Vorgefühle in therapeutischen Interventionsstudien berücksichtigen, weitere Interozeptionsparadigmen einbeziehen und die Entwicklung von allgemeinem Vorgefühl und Drang über die Lebensspanne hinweg untersuchen.
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Affiliation(s)
- Christina Schütteler
- Institut für Klinische Psychologie und Psychotherapie, Universität zu Köln, Deutschland
| | - Alexander L. Gerlach
- Institut für Klinische Psychologie und Psychotherapie, Universität zu Köln, Deutschland
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4
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Iverson AM, Black KJ. Why Tic Severity Changes from Then to Now and from Here to There. J Clin Med 2022; 11:5930. [PMID: 36233797 PMCID: PMC9570874 DOI: 10.3390/jcm11195930] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 09/23/2022] [Accepted: 10/05/2022] [Indexed: 11/29/2022] Open
Abstract
Much of the research regarding Tourette's syndrome (TS) has focused on why certain individuals develop tics while others do not. However, a separate line of research focuses on the momentary influences that cause tics to increase or decrease in patients who are already known to have TS or another chronic tic disorder (CTD). Environmental and internal variables such as fatigue, anxiety, and certain types of thoughts all have been shown to worsen tic severity and may even overcome the positive effects of treatment. Other influences such as stress, distraction, and being observed have had mixed effects in the various studies that have examined them. Still, other variables such as social media exposure and dietary habits have received only minimal research attention and would benefit from additional study. Understanding the impact of these environmental and internal influences provides an opportunity to improve behavioral treatments for TS/CTD and to improve the lives of those living with these conditions. This review will examine the current literature on how these moment-to-moment influences impact tic expression in those with TS/CTD.
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Affiliation(s)
- Ann M. Iverson
- School of Medicine, Washington University in St. Louis, St. Louis, MO 63110, USA
| | - Kevin J. Black
- Departments of Psychiatry, Neurology, Radiology and Neuroscience, Washington University in St. Louis, St. Louis, MO 63110-1010, USA
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5
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McGuire JF, Strum A, Ricketts EJ, Montalbano GE, Chang S, Loo SK, Woods DW, McCracken J, Piacentini J. Cognitive control processes in behavior therapy for youth with Tourette's disorder. J Child Psychol Psychiatry 2022; 63:296-304. [PMID: 34155637 PMCID: PMC10696898 DOI: 10.1111/jcpp.13470] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/20/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Cognitive control processes are implicated in the behavioral treatment of Tourette's disorder (TD). However, the influence of these processes on treatment outcomes has received minimal attention. This study examined whether cognitive control processes and/or tic suppression predicted reductions in tic severity and treatment response to behavior therapy. METHOD Fifty-three youth with TD or a pervasive tic disorder participated in a randomized wait list-controlled trial of behavior therapy. Following a baseline assessment to evaluate psychiatric diagnoses, tic severity, and cognitive control processes (e.g., response selection, inhibition, and suppression), youth were randomly assigned to receive eight sessions of behavior therapy (n = 23) or a wait list of equal duration (n = 28). Youth receiving immediate treatment completed a post-treatment assessment to determine improvement in tic severity. Meanwhile, youth in the wait list condition completed another assessment to re-evaluate tic severity and cognitive control processes, and subsequently received 8 sessions of behavior therapy followed by a post-treatment assessment to determine improvement. RESULTS A multiple linear regression model found that pretreatment inhibition/switching on the Delis-Kaplan Executive Function System Color-Word Interference Test predicted reductions in tic severity after behavior therapy (β = -.36, t = -2.35, p = .025, ƞ2 = .15). However, other cognitive control processes and tic suppression did not predict treatment response and/or reductions in tic severity. Small nonsignificant effects were observed in cognitive control processes after behavior therapy. CONCLUSION Cognitive control processes may influence tic severity reductions in behavior therapy. Notably, even when other cognitive control processes are impaired and youth are initially unable to voluntarily suppress their tics, youth with TD can still benefit from behavior therapy. Findings offer implications for clinical practice and research for TD.
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Affiliation(s)
- Joseph F. McGuire
- Department of Psychiatry and Behavioral Science, Johns Hopkins University School of Medicine
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
| | - Alexandra Strum
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
- Department of Psychology, Loyola Marymount University
| | - Emily J. Ricketts
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
| | | | - Susanna Chang
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
| | - Sandra K. Loo
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
| | | | - James McCracken
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
| | - John Piacentini
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
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6
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Bennett SM, Capriotti M, Bauer C, Chang S, Keller AE, Walkup J, Woods D, Piacentini J. Development and Open Trial of a Psychosocial Intervention for Young Children With Chronic Tics: The CBIT-JR Study. Behav Ther 2020; 51:659-669. [PMID: 32586437 DOI: 10.1016/j.beth.2019.10.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 10/09/2019] [Accepted: 10/13/2019] [Indexed: 11/29/2022]
Abstract
The Comprehensive Behavioral Intervention for Tic Disorders (CBIT) has demonstrated efficacy in large randomized controlled trials for children (≥9 yrs), adolescents and adults with Tourette Syndrome and Chronic Tic Disorders. Given the early age of onset for tic disorders, a large portion of affected individuals with chronic tic disorders are less than 9 years of age and appropriate developmental adaptations of behavioral treatment have not yet been tested. The goal of this study was to adapt and evaluate the acceptability and utility of a family-based adaptation of CBIT for children under 9 years of age. Children 5-8 years of age (N = 15) with chronic tics were recruited from three study sites. CBIT was adapted for use with young children and included habit reversal strategies introduced in a developmentally appropriate game format and function-based interventions to reduce family accommodation of and attention to tic symptoms. Children and parents described high level of treatment satisfaction and study retention rate was 100%. Treatment response rate was 54% (CGI-I = 1 or 2) with a significant decrease in the YGTSS total score (Cohen's d = 0.73) that was largely maintained at 3-month and 1-year follow-up assessments. Treatment was associated with reduction of some symptoms of tic-related comorbid syndromes and with changes in parental accommodation and attention to tics. Future research should determine if parental attention to tics and symptom accommodation are important mediators of treatment outcome, or if participating in this intervention at a younger age may prevent the chronic course of tic symptoms.
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Affiliation(s)
| | | | | | - Susanna Chang
- UCLA Semel Institute for Neuroscience and Human Behavior
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7
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Stiede JT, Woods DW. Pediatric Prevention: Tic Disorders. Pediatr Clin North Am 2020; 67:547-557. [PMID: 32443993 DOI: 10.1016/j.pcl.2020.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
It is not clear whether the development of tics can be prevented. Contextual variables can impact tic expression; therefore, shifting attention to behaviors that reduce tics is an important part of decreasing tic severity. Several medications are effective in reducing tic severity, but side effects restrict their use. Behavioral treatment is the gold standard psychotherapy intervention for tic disorders, with Comprehensive Behavioral Intervention for Tics being the most well-supported nonpharmacological treatment. Although children may be unable to prevent the development of tics, they can still use several strategies to reduce tic severity and impairment.
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Affiliation(s)
- Jordan T Stiede
- Psychology Department, Marquette University, Cramer Hall, 307, PO Box 1881, Milwaukee, WI 53201-1881, USA
| | - Douglas W Woods
- Marquette University, Holthusen Hall, 305, PO Box 1881, Milwaukee, WI 5320-1881, USA.
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8
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Yadegar M, Guo S, Ricketts EJ, Zinner SH. Assessment and Management of Tic Disorders in Pediatric Primary Care Settings. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2020; 6:159-172. [PMID: 32467820 DOI: 10.1007/s40474-019-00168-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Purpose of Review Pediatricians and other primary care providers are often the first and sole healthcare clinicians of patients who present with tics. However, limited primary care pediatric training in neuropsychiatric concerns, as well as perceived lack of comfort and preparation, make it challenging for these clinicians to confidently identify and manage tic disorders. Recent Findings Current empirical findings of tic disorder management relevant to pediatric physicians, including assessment, psychoeducation, behavioral interventions, psychotropic medications, and alternative treatments are reviewed. Summary This article discusses neuropsychiatric and medical complexities of tic disorder assessment, with particular emphasis on differential and comorbid diagnoses. Tiered referral recommendations, based on symptom severity, impairment, and consideration of comorbid conditions, are provided. Future directions for tic management, including dissemination of evidence-based treatments of tic disorders and multidisciplinary teams within pediatric primary care settings, are included.
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Affiliation(s)
- Mina Yadegar
- Univeristy of California, Los Angeles.,Boston Child Study Center - Los Angeles.,Behavioral Associates Los Angeles
| | - Sisi Guo
- Univeristy of California, Los Angeles
| | | | - Samuel H Zinner
- University of Washington School of Medicine.,Seattle Children's Hospital
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9
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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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10
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Nam SH, Park J, Park TW. Clinical Aspects of Premonitory Urges in Patients with Tourette's Disorder. Soa Chongsonyon Chongsin Uihak 2019; 30:50-56. [PMID: 32595321 PMCID: PMC7289498 DOI: 10.5765/jkacap.180025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 11/12/2018] [Accepted: 12/06/2018] [Indexed: 11/06/2022] Open
Abstract
Most patients with Tourette’s disorder experience an uncomfortable sensory phenomenon called the premonitory urge immediately before experiencing tics. It has been suggested that premonitory urges are associated with comorbidities such as obsessive compulsive disorder, anxiety disorders, and attention-deficit/hyperactivity disorder, although these associations have been inconsistent. Most patients experience tics as a result of the premonitory urges, and after the tics occur, most patients report that the premonitory urges are temporarily relieved. As a consequence, several studies have assessed the premonitory urge and its potential therapeutic utility. Based on the concept that the premonitory urge induces tics, behavioral treatments such as Exposure and Response Prevention and Habit Reversal Therapy have been developed. However, it is still unclear whether habituation, the main mechanism of these therapies, is directly related to their effectiveness. Moreover, the observed effects of pharmacological treatments on premonitory urges have been inconsistent.
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Affiliation(s)
- Seok Hyun Nam
- Department of Psychiatry, College of Medicine, Chonbuk National University, Jeonju, Korea
| | - Juhyun Park
- College of Medicine, Seoul National University, Seoul, Korea
| | - Tae Won Park
- Department of Psychiatry, College of Medicine, Chonbuk National University, Jeonju, Korea.,Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
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11
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Asakawa T, Sugiyama K, Nozaki T, Sameshima T, Kobayashi S, Wang L, Hong Z, Chen SJ, Li CD, Ding D, Namba H. Current behavioral assessments of movement disorders in children. CNS Neurosci Ther 2018; 24:863-875. [PMID: 30039925 DOI: 10.1111/cns.13036] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 06/26/2018] [Accepted: 06/29/2018] [Indexed: 11/30/2022] Open
Abstract
Pediatric movement disorders (PMDs) are common and have recently received increasing attention. As these disorders have special clinical features, the selection of appropriate behavioral assessment tools that can clearly distinguish movement disorders from other diseases (eg, epilepsy and neuromuscular disorders) is crucial for achieving an accurate diagnosis and treatment. However, few studies have focused on behavioral assessments in children. The present report attempts to provide a critical review of the available subjective and objective assessment tests for common PMDs. We believe that the principles of objectification, multi-purpose use, and simplification are also applicable to the selection and development of satisfactory pediatric behavioral assessment tools. We expect that the development of wearable sensors, virtual reality, and augmented reality will lead to the establishment of more reliable and simple tests. In addition, more rigorous randomized controlled trials that have been specifically designed to evaluate behavioral testing in children are also expected in the future.
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Affiliation(s)
- Tetsuya Asakawa
- Department of Neurosurgery, Hamamatsu University School of Medicine, Hamamatsu-city, Shizuoka, Japan.,Research Base of Traditional Chinese Medicine Syndrome, Fujian University of Traditional Chinese Medicine, Shangjie Minhou, Fuzhou, China
| | - Kenji Sugiyama
- Department of Neurosurgery, Hamamatsu University School of Medicine, Hamamatsu-city, Shizuoka, Japan
| | - Takao Nozaki
- Department of Neurosurgery, Hamamatsu University School of Medicine, Hamamatsu-city, Shizuoka, Japan
| | - Tetsuro Sameshima
- Department of Neurosurgery, Hamamatsu University School of Medicine, Hamamatsu-city, Shizuoka, Japan
| | - Susumu Kobayashi
- Department of Neurosurgery, Hamamatsu University School of Medicine, Hamamatsu-city, Shizuoka, Japan
| | - Liang Wang
- Department of Neurology, Huashan Hospital of Fudan University, Shanghai, China
| | - Zhen Hong
- Department of Neurology, Huashan Hospital of Fudan University, Shanghai, China.,Institute of Neurology, Huashan Hospital of Fudan University, Shanghai, China
| | - Shu-Jiao Chen
- Research Base of Traditional Chinese Medicine Syndrome, Fujian University of Traditional Chinese Medicine, Shangjie Minhou, Fuzhou, China
| | - Can-Dong Li
- Research Base of Traditional Chinese Medicine Syndrome, Fujian University of Traditional Chinese Medicine, Shangjie Minhou, Fuzhou, China
| | - Ding Ding
- Institute of Neurology, Huashan Hospital of Fudan University, Shanghai, China
| | - Hiroki Namba
- Department of Neurosurgery, Hamamatsu University School of Medicine, Hamamatsu-city, Shizuoka, Japan
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12
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Eaton CK, Jones AM, Gutierrez-Colina AM, Ivey EK, Carlson O, Melville L, Kardon P, Blount RL. The Influence of Environmental Consequences and Internalizing Symptoms on Children's Tic Severity. Child Psychiatry Hum Dev 2017; 48:327-334. [PMID: 27044052 DOI: 10.1007/s10578-016-0644-5] [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: 11/24/2022]
Abstract
Although there is evidence that environmental consequences for displaying tics and internalizing symptoms are related to tic severity in children with TS, less is known about the inter-relationships of these variables or how these factors jointly contribute to tic severity. This study included 45 children with Tourette syndrome. Caregivers reported on children's environmental consequences for displaying tics, internalizing symptoms, and tic severity. Results indicated that children with higher levels of internalizing symptoms experienced significantly more environmental consequences for displaying tics. Children with higher levels of separation anxiety symptoms demonstrated significantly greater tic severity. Environmental consequences for displaying tics accounted for significantly more variance in predicting tic severity than anxiety symptoms. This preliminary evidence suggests that environmental consequences for displaying tics, such as receiving accommodations or attention from others, have a greater influence on children's tic severity than emotional factors.
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Affiliation(s)
- Cyd K Eaton
- Department of Psychology, University of Georgia, 125 Baldwin Street, Athens, GA, 30602, USA.
| | - Anna M Jones
- Department of Psychology, University of Georgia, 125 Baldwin Street, Athens, GA, 30602, USA
| | - Ana M Gutierrez-Colina
- Department of Psychology, University of Georgia, 125 Baldwin Street, Athens, GA, 30602, USA
| | - Emily K Ivey
- Department of Psychology, University of Georgia, 125 Baldwin Street, Athens, GA, 30602, USA
| | - Olivia Carlson
- Department of Psychology, University of Georgia, 125 Baldwin Street, Athens, GA, 30602, USA
| | - Lauren Melville
- Department of Psychology, University of Georgia, 125 Baldwin Street, Athens, GA, 30602, USA
| | - Patricia Kardon
- Tourette Information Center and Support (TICS) of Georgia/Camp Twitch & Shout, Dunwoody, GA, USA
| | - Ronald L Blount
- Department of Psychology, University of Georgia, 125 Baldwin Street, Athens, GA, 30602, USA
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13
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Storch EA, Johnco C, McGuire JF, Wu MS, McBride NM, Lewin AB, Murphy TK. An initial study of family accommodation in children and adolescents with chronic tic disorders. Eur Child Adolesc Psychiatry 2017; 26:99-109. [PMID: 27277754 DOI: 10.1007/s00787-016-0879-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 06/01/2016] [Indexed: 12/15/2022]
Abstract
This initial study examined the nature, incidence, and clinical correlates of family accommodation in youth with tic disorders, and validated a brief self-report measure of tic-related family accommodation, the Tic Family Accommodation Scale (TFAS). Seventy-five youth aged 6-18 who were diagnosed with a tic disorder and their parent completed a diagnostic clinical interview, and clinician and parent-report measures of tic severity, depressive symptoms, anxiety symptoms, behavioral problems, family accommodation and impairment. An exploratory factor analysis of the TFAS showed a two-factor structure, with good internal consistency for the Total score, Modification of Child Environment and Modification of Parent Environment subscales (α = 0.88, 0.86, and 0.81, respectively). Family accommodation was not associated with tic severity. Family accommodation was associated with increased anxiety and depressive symptoms, higher externalizing, rule breaking, aggressive behaviors and social problems, and with greater tic-related functional impairment. Anxiety and externalizing problems (but not depressive symptoms) predicted family accommodation when controlling for tic severity. Family accommodation predicted high levels of functional impairment over and above the effect of tic severity, anxiety, depression and externalizing problems. Family accommodation is a common phenomenon for youth with tic disorders, with modifications typically encompassing changes to the child and/or parent environments. Accommodation was not associated with tic severity, but was related to higher levels of anxiety, depressive symptoms, externalizing symptoms, aggression, and rule breaking behaviors. Results suggest that other emotional symptoms are more likely to drive accommodation practices than the tic symptoms per se.
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Affiliation(s)
- Eric A Storch
- Department of Pediatrics, University of South Florida, Box 7523, 880 6th Street South, St. Petersburg, FL, 33701, USA.
- Department of Health Policy and Management, University of South Florida, Tampa, USA.
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, USA.
- Department of Psychology, University of South Florida, Tampa, USA.
- Rogers Behavioral Health, Tampa Bay, Tampa, USA.
- All Children's Hospital, Johns Hopkins Medicine, St. Petersburg, USA.
| | - Carly Johnco
- Department of Pediatrics, University of South Florida, Box 7523, 880 6th Street South, St. Petersburg, FL, 33701, USA
| | - Joseph F McGuire
- Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, USA
| | - Monica S Wu
- Department of Pediatrics, University of South Florida, Box 7523, 880 6th Street South, St. Petersburg, FL, 33701, USA
- Department of Psychology, University of South Florida, Tampa, USA
| | - Nicole M McBride
- Department of Pediatrics, University of South Florida, Box 7523, 880 6th Street South, St. Petersburg, FL, 33701, USA
| | - Adam B Lewin
- Department of Pediatrics, University of South Florida, Box 7523, 880 6th Street South, St. Petersburg, FL, 33701, USA
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, USA
- Department of Psychology, University of South Florida, Tampa, USA
| | - Tanya K Murphy
- Department of Pediatrics, University of South Florida, Box 7523, 880 6th Street South, St. Petersburg, FL, 33701, USA
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, USA
- All Children's Hospital, Johns Hopkins Medicine, St. Petersburg, USA
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Houghton DC, Capriotti MR, Conelea CA, Woods DW. Sensory Phenomena in Tourette Syndrome: Their Role in Symptom Formation and Treatment. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2014; 1:245-251. [PMID: 25844305 DOI: 10.1007/s40474-014-0026-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The primary symptoms of Tourette Syndrome (TS) are motor and vocal tics, but increasingly, researchers have examined the role of sensory phenomena in biobehavioral models of the disorder. These sensory phenomena involve tic-related premonitory urge sensations as well as potential abnormalities in the perceptual and behavioral experiences associated with external sensory input. As such, dysfunctional sensorimotor integration might represent a key facet of TS pathology. The current paper reviews the literature on sensory phenomena in tic disorders and highlights possible connections to TS symptoms and directions for future research.
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Affiliation(s)
- David C Houghton
- Department of Psychology, Texas A&M University, 4235 TAMU, College Station, TX 77843
| | - Matthew R Capriotti
- Department of Psychology, University of Wisconsin-Milwaukee, 224 Garland Hall, 2441 E. Hartford Ave, Milwaukee, WI, 53211
| | - Christine A Conelea
- Bradley Hasbro Children's Research Center, Alpert Medical School of Brown University, One Hoppin Street, Providence, RI, 02903
| | - Douglas W Woods
- Department of Psychology, Texas A&M University, 4235 TAMU, College Station, TX, 77843
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