A Preliminary Investigation of the Effects of Aerobic Exercise on Childhood Tourette’s Syndrome and OCD

October 26, 2014 by  
Filed under Featured, Research

I’m delighted to share the results of a preliminary investigation into the effects of aerobic exercise on tics, OCD, and anxiety in children – in no small part because the study was my daughter’s doctoral research.

Here’s a snippet from the article:

Despite a considerable amount of re- search exploring the effects of aerobic exer- cise on OCD and other types of disorders (e.g., Abrantes et al., 2009; Broman-Fulks & Storey, 2008; Brown et al., 2007; Gordon et al., 2010; Lancer et al., 2007; Newman & Motta, 2007; Smits et al., 2008), little is known about the effects for individuals with comorbid TS and OCD. Considering that OCD is an anxiety disorder, and that tics can be exacerbated by anxiety, it is possible that a reduction in symptoms of anxiety could result in a concurrent reduction in symptoms of TS as well as those of OCD. This study sought to explore the effects of aerobic exercise on childhood symptoms of TS, OCD, and anxiety. The results offer support for the value of exercise in reducing TS, OCD, and anxiety. A 6-week treatment of two brief exercise sessions per week of moderate-intensity aerobic exercise yielded large reductions in symptoms of TS and OCD, and moderate to large reductions in symptoms of anxiety.

While all participants reported a de- crease in symptoms during the intervention phase, long-term effects of exercise on symptoms were inconclusive.

You can access the full article (free):

Packer-Hopke L., Motta R. W.. A Preliminary Investigation of the Effects of Aerobic Exercise on Childhood Tourette’s Syndrome and OCD. Association for Behavior and Cognitive Therapies. 2014 (37) pp. 188- 192 (pdf).

Omega 3 may help children with inattentive subtype of ADHD over and above collaborative problem-solving treatment

October 26, 2014 by  
Filed under Research

Via Dr. Ken Pope’s terrific mail list, this press release from the University of Gothenburg:

Supplements of the fatty acids omega 3 and 6 can help children and adolescents who have a certain kind of ADHD. These are the findings of a dissertation at the Sahlgrenska Academy, which also indicates that a special cognitive training program can improve problem behavior in children with ADHD.

Between three to six percent of all school age children are estimated to have ADHD (Attention Deficit Hyperactivity Disorder). ADHD is a disorder that entails a difficulty controlling impulses and temper, sitting still, waiting, or being attentive for more than short periods at a time. There are various kinds of ADHD where disturbances in attention, hyperactivity and impulsivity have varying degrees of prominence.

ADHD is often treated with stimulant medications, which are effective for most, but do not work for everyone.

Relevant improvement

In this study, 75 children and adolescents with ADHD were given either the fatty acids omega 3 and 6 or a placebo over three months, and then they were all given omega 3/6 over three months. The study was conducted double-blind, which means that neither the researchers nor the participants were allowed to know whether they received the active capsules until afterwards.

“For the group as a whole, we did not see any major improvement, but in 35 percent of the children and adolescents who have the inattentive subtype of ADHD called ADD, the symptoms improved so much that we can talk about a clinically relevant improvement,” says Mats Johnson, doctoral student at the Sahlgrenska Academy at the University of Gothenburg.

Cognitive training

The levels of omega 3 and omega 6 were also measured in blood samples, where those who had a clear improvement of their symptoms also showed a better balance between the blood levels of these two fatty acids.

The dissertation also indicates that a cognitive training method called Collaborative Problem Solving (CPS) can be a good alternative or complement in the treatment of ADHD and oppositional defiant disorder (ODD).

Solving problematic situations

With this method the children and the family receives help in training cognitive ability and solving problematic situations. The study included 17 children, whose families received up to ten weeks of CPS sessions. The families were then asked how much the behavioral problems improved directly after the treatment as well as six months afterwards.

“Our study of CPS as a treatment for ADHD and ODD is the first in Sweden. All families in our study completed the treatment, and half of them experienced a large or very large improvement of the behavioral problems,” says Mats Johnson.

Combination treatment

The patient group that still had severe ADHD symptoms when the CPS treatment was complete were given the opportunity to supplement treatment with stimulants medication. In the follow-up six months later, 81 percent of all of the participating families experienced a large or very large improvement.

According to Mats Johnson, this indicates that CPS can improve problem-creating behavior in children ADHD and ODD, and that children with severe ADHD symptoms can be improved with a combination of CPS and ADHD medication.

The research was conducted at the Gillberg Neuropsychiatry Centre at the University of Gothenburg.

The dissertation “Non-stimulant interventions in ADHD” was defended at a public defense on October 3.

Link to dissertation

Contact:
Mats Johnson, doctoral student at the Sahlgrenska Academy, University of Gothenburg
+46-76-2109103
+46-31-3425951
mats.johnson@gnc.gu.se

N.H. special education school faces abuse allegations

October 26, 2014 by  
Filed under Advocacy, Commentary

James Vaznis reports:

Two families filed a federal lawsuit Wednesday against a highly regarded residential and day school for special education students in New Hampshire, alleging that several staff members verbally or physically abused their children.

In one instance, a classroom aide at the school run by the Crotched Mountain Foundation, in Greenfield, N.H., is accused of taking a picture of a naked 7-year-old boy on a toilet and posting it temporarily on the Internet while another aide laughed about the picture with colleagues, according to the civil lawsuit filed in the federal courthouse in Concord, N.H.

Read more on Boston Globe.

The allegations are horrifying, but as I read the news story, I found myself also wondering about what the U.S. Education Department (USED) might do over what appears to be allegations of violating the child’s privacy by uploading a picture of him naked to the Internet. Will they say that the picture is not an “education record,” and therefore it’s not a FERPA issue? I suspect they might.

Will the USED Office of Civil Rights open an investigation and possibly deny federal funds to the school for violations of students’ civil rights? They could, I think, but I somehow doubt that they will.

In any event, such abuse, if the allegations are true, does need to be prosecuted criminally. And schools need to be sued civilly to ensure they properly screen, train, and monitor aides.

Temporal course of the tourette syndrome clinical triad.

October 25, 2014 by  
Filed under Research

A recently published study looks at the sequence in which tics, ADHD, and OCD emerges in development. In contrast to earlier studies that suggested that ADHD symptoms are usually evident earlier than tic symptoms, this study found that both emerged at around the same time. Because this is a retrospective survey, the accuracy of the findings depends, in part, on how accurate the participants’ memories are. Then, too, the survey does not ask the patients’ parents what their recall is of how symptoms emerged and when. Here’s the abstract:

BACKGROUND: Tourette syndrome (TS) is a disorder characterized by childhood onset of motor and phonic tics, often with improvement of tic symptoms by young adult years. The temporal course of tics and commonly comorbid behavioral symptoms is still not well characterized.
METHODS: In order to clarify the time course of tics and comorbid attention deficit hyperactivity disorder (ADHD) or obsessive compulsive disorder (OCD) in TS, we administered a brief survey regarding the course of symptoms at a single point in time to 53 TS patients aged 13-31 years.
RESULTS: Mean age (±SD) at symptom onset was 7.9 (±3.6) years for tics, 7.9 (±3.5) for ADHD, and 9.2 (±5.0) for OCD. Age at peak symptom severity was 12.3 (±4.6) years for tics, 10.8 (±3.8) for ADHD, and 12.6 (±5.5) for OCD. Tics, ADHD, and OCD were reported to be no longer present in 32.0%, 22.8%, and 21.0% of subjects, respectively. Decline in symptom severity began at age 14.7 (±3.7) years for tics, 13.9 (±2.9) for ADHD, and 15.1 (±5.0) for OCD. Remission of symptoms occurred at age 17.4 (±3.8) years for tics, 17.4 (±1.3) for ADHD, and 15.6 (±2.3) for OCD.
DISCUSSION: Our data confirm and expand previously reported TS spectrum symptom milestones and may guide design of future research aimed at improving the course of TS.

Reference:
Shprecher DR1, Rubenstein LA2, Gannon K1, Frank SA3, Kurlan R4.. Temporal course of the tourette syndrome clinical triad. Tremor Other Hyperkinet Mov (N Y). 2014 Sep 26;4:243. doi: 10.7916/D8HD7SV6. eCollection 2014.

You can access the full article for free here.

Intensive outpatient comprehensive behavioral intervention for tics

October 25, 2014 by  
Filed under Research

A new study attempted to evaluate whether CBIT (Comprehensive Behavioral Intervention for Tics) could be provided intensively on an outpatient basis. Although the study reports only two cases and the study lacks important research controls, the results are promising and bear further investigation. Here’s the abstract:

Recent randomized clinical trials have established the efficacy of Comprehensive Behavioral Intervention for Tics (CBIT) in treating children and adults with Tourette syndrome and persistent tic disorders. However, the standard CBIT protocol uses a weekly outpatient treatment format (i.e., 8 sessions over 10 wk), which may be inconvenient or impractical for some patients, particularly patients, who are required to travel long distances in order to receive care. In contrast, an intensive outpatient program may increase accessibility to evidence-based behavioral treatments for Tourette syndrome and other persistent tic disorders by eliminating the necessity of repeated travel. This case series evaluated the use of an intensive outpatient program CBIT (IOP CBIT) for the treatment of 2 preadolescent males (ages 10 and 14 years) with Tourette syndrome. The IOP CBIT treatment protocol included several hours of daily treatment over a 4-d period. Both children evidenced notable reductions in their tics and maintained treatment gains at follow-up. Moreover, both patients and their parents expressed treatment satisfaction with the IOP CBIT format. This case series addresses an important research gap in the behavioral treatment of tic disorders literature. The patients’ treatment outcomes indicate that IOP CBIT is a promising treatment that warrants more systematic investigation.

Reference:

Blount TH, Lockhart AL, Garcia RV, Raj JJ, Peterson AL Intensive outpatient comprehensive behavioral intervention for tics: A case series. World J Clin Cases. 2014 Oct 16;2(10):569-77. doi: 10.12998/wjcc.v2.i10.569.

You can access the full article for free here.

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