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Soler N, Perkes IE, Dale RC, Bray P. Parent-young person lived experience of sensory dysregulation in children with tic disorders: a qualitative study. Disabil Rehabil 2024:1-19. [PMID: 39324587 DOI: 10.1080/09638288.2024.2403727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 09/06/2024] [Accepted: 09/07/2024] [Indexed: 09/27/2024]
Abstract
PURPOSE To understand the breadth of sensory dysregulation on participation in daily tasks for young people with tic disorders, as research identified that sensory dysregulation experiences are broader than the symptoms being assessed. METHODS Eighteen semi-structured interviews were conducted with 16 families with children (5-16 years) with tic disorders. Interviews ranged from 45 to 120 min and were transcribed verbatim. Data collected from parents and young people were analysed and coded together. Thematic analysis using inductive and open coding methods was implemented using NVivo. RESULTS The impact of sensory dysregulation on daily life may be understood through the higher-order theme: ''sensory, emotions and tics; it's a ticking time bomb'', and three subthemes: (1) we sacrifice and adapt to get daily activities done in the home, (2) my child's experience of the community environment hinders participation, and (3) sensory preferences impact our entire family. CONCLUSION Sensory dysregulation experiences impact the entire family's quality of life, yet patient-reported sensory measures do not adequately capture the impact on the family unit and breath of symptoms. A sensory-based measure for children with tics is needed to comprehensively assess sensory dysregulation sensitivities for this population, ensuring patients' needs and effectiveness of therapy can be measured.
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Affiliation(s)
- Nicolette Soler
- Department of Psychological Medicine, The Sydney Children's Hospitals Network, Sydney, Australia
- Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Iain E Perkes
- Department of Psychological Medicine, The Sydney Children's Hospitals Network, Sydney, Australia
- Discipline of Psychiatry & Mental Health and Discipline of Paediatrics & Children's Health, School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Kensington, Australia
- School of Women's and Children's Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| | - Russell C Dale
- Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Department of Paediatric Neurology, The Children's Hospital at Westmead, Sydney, Australia
- Kids Neuroscience Centre, and Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - Paula Bray
- The Sydney Children's Hospitals Network, Sydney, Australia and School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Furlong Y, Koonamave RL, Sarich E, Chen W. Refractory case of Tourette's syndrome treated successfully with comprehensive behavioural therapy and aripiprazole. J Paediatr Child Health 2022; 58:539-541. [PMID: 34036662 DOI: 10.1111/jpc.15584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 05/06/2021] [Accepted: 05/15/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Yulia Furlong
- Child and Adolescent Mental Health Service, Perth Children's Hospital, Perth, Western Australia, Australia.,School of Paediatrics, University of Western Australia, Perth, Western Australia, Australia
| | - Rose Lazar Koonamave
- Department of Paediatrics, Armadale Health Services, Perth, Western Australia, Australia
| | - Elissa Sarich
- Child and Adolescent Mental Health Service, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Wai Chen
- Mental Health Service, Fiona Stanley Hospital, Perth, Western Australia, Australia.,Graduate School of Education, University of Western Australia, Perth, Western Australia, Australia.,School of Medicine, University of Notre Dame Australia, Fremantle, Western Australia, Australia.,Graduate School of Education, Murdoch University, Perth, Western Australia, Australia
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Licciardi L, Brown T. An overview & critical review of the Sensory Profile - second edition. Scand J Occup Ther 2021:1-13. [PMID: 34057881 DOI: 10.1080/11038128.2021.1930148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND The Sensory Profile-2 (SP-2) is the recently revised set of scales that provide information about a child's responses to different types of sensory stimuli. AIM To examine the methodological quality and psychometric properties of the SP-2 using the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) and Quality Criteria for Health Status Questionnaires (QCHSQ). MATERIALS AND METHODS The methodological quality and psychometric properties for each of the SP-2 scales were examined by two assessors using the COSMIN and QCHSQ. RESULTS The COSMIN revealed that the SP-2 demonstrated strengths in patient-related outcome measure design and internal consistency. However, hypothesis testing, cross-cultural validity and structural validity (construct validity) were notable shortcomings. The QCHSQ indicated the SP-2 has merits in its content validity and construct validity. The SP-2 manual reported insufficient evidence of its responsiveness, interpretability and criterion validity. CONCLUSION Informed assessment selection is fundamental for evidence-based and quality occupational therapy practice provision. Overall, the SP-2 is considered to have adequate psychometric properties, however users should be mindful of the identified shortcomings. SIGNIFICANCE The review and critique of the SP-2 adds to the body of knowledge about the revised instrument and provides an objective perspective about its strengths and weaknesses.
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Affiliation(s)
- Lisa Licciardi
- Department of Occupational Therapy, Faculty of Medicine, Nursing and Health Sciences, School of Primary and Allied Health Care, Monash University Peninsula Campus, Frankston, Victoria, Australia
| | - Ted Brown
- Department of Occupational Therapy, Faculty of Medicine, Nursing and Health Sciences, School of Primary and Allied Health Care, Monash University Peninsula Campus, Frankston, Victoria, Australia
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Isaacs D, Riordan H. Sensory hypersensitivity in Tourette syndrome: A review. Brain Dev 2020; 42:627-638. [PMID: 32600840 DOI: 10.1016/j.braindev.2020.06.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 04/06/2020] [Accepted: 06/07/2020] [Indexed: 12/12/2022]
Abstract
Tourette syndrome (TS) is a neurodevelopmental disorder defined by tics, but most patients also experience bothersome sensory phenomena, in the form of premonitory urges and/or sensory hypersensitivity. Whereas premonitory urges are temporally paired with tics, sensory hypersensitivity is a constant, heightened awareness of external and/or internal stimuli. The intensity of sensory hypersensitivity does not strongly correlate with the severity of tics or premonitory urges, suggesting it is a dissociable clinical phenomenon. At least 80% of TS patients report subjectively enhanced perception of various sensory stimuli. These same patients demonstrate normal static detection thresholds. However, individuals with TS habituate abnormally to repetitive stimuli, indicating incapacity to appropriately filter redundant sensory input, i.e. impaired sensory gating. Physiologic support for this hypothesis is provided by abnormal pre-pulse inhibition (PPI) and event-related potential (ERP) investigations. Preclinical data implicates parvalbumin-positive (PV+) interneuron dysfunction in altered sensory gating in TS and other neurodevelopment disorders. Studies probing TS sensory hypersensitivity must methodically account for comorbid psychiatric conditions, namely obsessive compulsive disorder (OCD), attention deficit hyperactivity disorder (ADHD), and autism spectrum disorder (ASD), as these entities appear to involve pathophysiologic processes shared with TS. The presence of psychiatric comorbidities in TS is associated with even more profound sensory processing dysfunction. A deepened understanding of TS sensory hypersensitivity will afford novel insights into disease mechanisms, clinical phenotype, and therapeutic management.
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Affiliation(s)
- David Isaacs
- Department of Neurology, Division of Movement Disorders, Vanderbilt University Medical Center, A-0118 Medical Center North, Nashville, TN 37232, United States.
| | - Heather Riordan
- Department of Pediatrics, Division of Child Neurology, Vanderbilt Children's Hospital, United States
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Isaacs D, Key AP, Cascio CJ, Conley AC, Walker HC, Wallace MT, Claassen DO. Sensory Hypersensitivity Severity and Association with Obsessive-Compulsive Symptoms in Adults with Tic Disorder. Neuropsychiatr Dis Treat 2020; 16:2591-2601. [PMID: 33173296 PMCID: PMC7646442 DOI: 10.2147/ndt.s274165] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 10/03/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Sensory hypersensitivity, defined as heightened awareness of and reactivity to external stimuli, is a bothersome symptom that affects up to 80% of adults with Tourette syndrome (TS). Such widespread prevalence suggests sensory hypersensitivity is a core feature of the disorder, but its severity and association with other clinical features of TS remain largely unexplored. Complicating matters, sensory hypersensitivity has been observed in two neurodevelopmental disorders commonly comorbid with TS: obsessive-compulsive disorder (OCD) and attention deficit hyperactivity disorder (ADHD). OBJECTIVE We sought to measure sensory hypersensitivity in TS patients relative to healthy controls and to investigate the relationship of sensory hypersensitivity with OCD and ADHD symptoms in the context of TS. METHODS We recruited 34 adults with TS or chronic tic disorder to undergo evaluation with the Yale Global Tic Severity Scale (YGTSS) and a battery of validated self-report instruments assessing sensory hypersensitivity (Sensory Gating Inventory, SGI; Sensory Perception Quotient, SPQ), premonitory urge (Premonitory Urge to Tic Scale, PUTS), OCD (Dimensional Obsessive-Compulsive Scale, DOCS), and ADHD (Adult ADHD Self-Report Screening Scale for DSM-5, ASRS-V). Age- and sex-matched healthy controls were recruited to complete SGI and psychiatric measures. RESULTS SGI and SPQ scores strongly correlated (r s = -0.73, p < 0.0001) within patients. SGI total score was significantly higher in patients versus controls (119.0 vs 67.6, U =-5.3, p < 0.0001), indicating greater sensory hypersensitivity in the tic disorder group. SGI score correlated modestly with PUTS, DOCS, and ASRS-V scores but not with YGTSS total tic score. Hierarchical linear regression analysis revealed that, of the tested variables, only DOCS score contributed significantly to mean SGI score, with β ranging from 1.03 (p = 0.044) to 1.41 (p = 0.001). A simple linear regression model with DOCS as the independent variable accounted for 31.9% of SGI score variance. CONCLUSION Sensory hypersensitivity is prominent in adults with tic disorder and is independently associated with obsessive-compulsive symptom severity.
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Affiliation(s)
- David Isaacs
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Alexandra P Key
- Center for Cognitive Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Hearing and Speech Sciences, Vanderbilt University, Nashville, TN, USA.,Vanderbilt Kennedy Center, Vanderbilt University, Nashville, TN, USA
| | - Carissa J Cascio
- Vanderbilt Kennedy Center, Vanderbilt University, Nashville, TN, USA.,Frist Center for Autism and Innovation, Vanderbilt University, Nashville, TN, USA.,Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Alexander C Conley
- Center for Cognitive Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Harrison C Walker
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mark T Wallace
- Department of Hearing and Speech Sciences, Vanderbilt University, Nashville, TN, USA.,Frist Center for Autism and Innovation, Vanderbilt University, Nashville, TN, USA.,Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Pharmacology, Vanderbilt University, Nashville, TN, USA.,Department of Psychology, Vanderbilt University, Nashville, TN, USA
| | - Daniel O Claassen
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
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Soler N, Hardwick C, Perkes IE, Mohammad SS, Dossetor D, Nunn K, Bray P, Dale RC. Sensory dysregulation in tic disorders is associated with executive dysfunction and comorbidities. Mov Disord 2019; 34:1901-1909. [PMID: 31505086 DOI: 10.1002/mds.27817] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 07/04/2019] [Accepted: 07/19/2019] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Tics are conceptualized as a sensorimotor phenomenon with a premonitory urge typically described by patients. As observed in other neurodevelopmental disorders, we have observed sensory dysregulation symptoms, such as tactile hypersensitivity to clothing, in children with tic disorders; however, formal clinical research in this area is limited. OBJECTIVE To define the presence of sensory dysregulation symptoms in tic disorders, and their clinical associations. METHODS Prevalence of sensory dysregulation in 102 children with tic disorders was compared to 61 age- and sex-matched healthy controls. Sensory dysregulation, executive function, and quality of life data were obtained through the Short Sensory Profile-2, Sensory Profile-2, Sensory Processing Measure, Behaviour Rating Inventory of Executive Function-2, and Strength and Difficulties Questionnaire and Pediatric Quality of Life Inventory. Tics were assessed with the Yale Global Tic Severity Scale. RESULTS Children with tics, in the presence of comorbidity, had elevated sensory dysregulation compared to healthy controls (P < 0.001). There was a positive correlation between sensory dysregulation and global executive difficulties in children with tics and comorbidity (n = 87; rho = 0.716; P < 0.001) and a negative correlation of sensory dysregulation with quality of life (n = 87; rho = -0.595; P < 0.001). In children with tics, there was an association between sensory dysregulation and number of comorbidities (P < 0.001). CONCLUSION In the presence of comorbidity, children with tic disorders have broad sensory dysregulation symptoms beyond the premonitory urge. There was a statistically significant association between sensory dysregulation and executive function difficulties and the presence of neurodevelopmental and psychiatric comorbidity. Sensory dysregulation can be considered neurodevelopmental symptoms, providing insight into the neurobiology of tics and opportunities for therapeutic intervention. © 2019 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Nicolette Soler
- Department of Psychological Medicine, The Children's Hospital at Westmead, Sydney, Australia.,Faculty of Medicine and Health, The University of Sydney, Children's Hospital Westmead Clinical School, Sydney, Australia
| | - Chris Hardwick
- Department of Psychological Medicine, The Children's Hospital at Westmead, Sydney, Australia
| | - Iain E Perkes
- Department of Psychological Medicine, The Children's Hospital at Westmead, Sydney, Australia.,Faculty of Medicine and Health, The University of Sydney, Children's Hospital Westmead Clinical School, Sydney, Australia.,The University of New South Wales, School of Psychiatry, Faculty of Medicine, & School of Psychology, Faculty of Science, Sydney, Australia
| | - Shekeeb S Mohammad
- Department of Pediatric Neurology, The Children's Hospital at Westmead, Sydney, Australia.,Faculty of Medicine and Health, The University of Sydney, Children's Hospital Westmead Clinical School, Sydney, Australia
| | - David Dossetor
- Department of Psychological Medicine, The Children's Hospital at Westmead, Sydney, Australia.,Faculty of Medicine and Health, The University of Sydney, Children's Hospital Westmead Clinical School, Sydney, Australia
| | - Kenneth Nunn
- Department of Psychological Medicine, The Children's Hospital at Westmead, Sydney, Australia.,Faculty of Medicine and Health, The University of Sydney, Children's Hospital Westmead Clinical School, Sydney, Australia
| | - Paula Bray
- The University of Sydney, Faculty of Health Sciences, Sydney, Australia
| | - Russell C Dale
- Department of Pediatric Neurology, The Children's Hospital at Westmead, Sydney, Australia.,Faculty of Medicine and Health, The University of Sydney, Children's Hospital Westmead Clinical School, Sydney, Australia.,Kids Neuroscience Centre, and Brain and Mind Centre, Sydney, Australia
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