Tic severity in adolescents with Tourette’s syndrome (TD) can be influenced by cognitive control processes, according to the results of a randomized, waiting-list-controlled study published in the Journal of Child Psychology and Psychiatry.
The study researchers recruited adolescents (N = 53) aged 9 to 14 years with TD or chronic motor tic disorder at the University of California, Los Angeles, between 2007 and 2011. The participants were randomly given 8 sessions of manualized behavior therapy over 10 weeks or the same waiting list.
At the beginning and after the follow-up, the study researchers assessed adolescents using the Yale Global Tic Severity Scale (YGTSS), Premonitory Urge for Tics Scale (PUTS), Attention Network Task (ANT), Stop-Signal Task (SST), Go-No Go – Task, Delis-Kaplan Executive Function System Color-Word Interference Test (D-KEFS CWIT) and a tic suppression task.
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Participants had a mean age of 10.93 (standard deviation [SD], 1.62) years, 71.70% were boys, 58.5% were white, 49% had anxiety disorders, 35.8% had attention deficit hyperactivity disorder, and 30% had obsessive-compulsive disorder. The mean intelligence was 107.37 (standard deviation [SD], 12.49).
At the start of the study, the mean YGTSS total tic score was 25.83 (SD 6.19), the YGTSS impairment score 25.04 (SD 8.55), the PUTS score 23.17 (SD 5.36), the ANT incongruent accuracy was 39.62 (SD 8.64), SST response time was 303.83 (SD, 102.96), go-no-go commission errors were 22.96 (SD, 7.62), D-KEFS CWIT was 10.71 (SD, 2.78) and the tic suppression score was 42.94 (SD, 42.72). Adolescents randomly assigned to therapeutic intervention had higher YGTSS impairment scores (mean 27.70 vs 22.78; P = 0.04).
In the active treatment arm, 41.5% showed a post-behavioral response and there was a significant effect of time (F[1,45], 45.79; 2, 0.50; P <0.001)).
Baseline inhibition / switching score of D-KEFS-CWIT-predicted treatment response (b, -0.36; t, -2.35; ƞ2, 0.15; P = 0.025). Response to behavior therapy was not assessed by the YGTSS total score (t, 1.91; P = .08), the PUTS total score (t, -0.56; P = 0.58), or tic suppressibility (t , -1.07; P = 0.30) predicted).
Stratified according to responder and non-responder status, effect sizes for ANT-incongruent accuracy (0.7 vs 0.16), SST reaction time (0.7 vs 0.15), go-no-go commission errors (0, 22 vs 0.03) and D-KEFS CWIT (0.4 vs 0.38) differentiated or
In responders (d-range 0.4-0.38) compared to non-responders (d-range 0.4-0.22), moderate reinforcing effects on cognitive control processes were observed through behavioral therapy.
This study may have been limited by assessing only aspects of cognitive control that were a priori believed to be related to TD.
The study authors concluded that inhibitory control, not other cognitive control processes, predicted treatment response to behavioral therapy for tic in adolescents with TD.
reference
McGuire JF, Sturm A, Ricketts EJ et al. Cognitive control processes in behavior therapy in adolescents with Tourette’s syndrome. J Child psychiatry. Published online June 21, 2021. doi: 10.1111 / jcpp.13470
