Environmental factors in Tourette syndrome

A recent study by Pieter  Hoekstra, Andrea Dietrich, Mark  Edwards, Ishraga Elamin,  and Davide Martino reviews some the literature on prenatal and perinatal environmental factors that may influence the onset and course of  Tourette syndrome. From the abstract, some key points:

•  Pregnancy-related noxious exposures may be more frequent in pregnancies of children who will develop TS, particularly maternal smoking and prenatal life stressors experienced by the mother.
• Low birth weight and use of forceps delivery may be associated with greater tic severity, and my also increase the rate or risk of ADHD and OCD.
• Psychosocial stress remains the most important contextual factor influencing tic severity, as confirmed by prospective studies.

While correlation does not prove causation, the link between maternal smoking during pregnancy and ADHD and TS has been documented for decades. If you’re pregnant, you may not be able to control all the external stressors in your life, but if you haven’t cut down or quit smoking already, speak to your doctor about getting help.

Current Status of Neurofeedback for ADHD

For years, people have asked me whether I recommend neurofeedback – a form of biofeedback – for the treatment of ADHD.  And for years, I answered them that I didn’t think there were sufficient data from adequately controlled studies to conclude that neurofeedback is an effective treatment.  A recently published study in  Current Psychiatry Reports reviews the available research.

In their study, Lofthouse, Arnold, and Hurt considered data from eight randomized controlled studies that had reported moderate effect sizes on the core symptoms of ADHD (inattention and hyperactivity/impulsivity).  From the abstract of their study:

Unfortunately, the benefit reported from randomized studies has not been observed in the few small blinded studies conducted. Main study strengths include randomization, evidence-based diagnostic assessments, multi-domain treatment outcomes, use of some type of blinding, and sham control conditions. Main study limitations include lack of large samples, abnormal EEG participant selection, double-blinding, and testing of blind validity and sham inertness. Most recently, a collaborative NF research group has been planning a definitive double-blind well-controlled trial.

I haven’t obtained the full report yet, but to translate the above, what they’re saying is that as yet, we are still missing the kind of controlled research that would really enable people to determine whether neurofeedback is really of benefit in the treatment of ADHD.

Emerging Support for a Role of Exercise in ADHD Treatment?

In October, a study was published in Current Psychiatry Reports that may be of interest to some readers.

Here is the abstract of the report by Berwid  and Halperin:

Recent years have seen an expansion of interest in non-pharmacological interventions for attention-deficit/hyperactivity disorder(ADHD). Although considerable treatment development has focused on cognitive training programs, compelling evidence indicates that intense aerobic exercise enhances brain structure and function, and as such, might be beneficial to children with ADHD. This paper reviews evidence for a direct impact of exercise on neural functioning and preliminary evidence that exercise may have positive effects on children with ADHD. At present, data are promising and support the need for further study, but are insufficient to recommend widespread use of such interventions for children with ADHD.

Reference:
Curr Psychiatry Rep. 2012 Oct;14(5):543-51.
Emerging support for a role of exercise in attention-deficit/hyperactivity disorder intervention planning.
Berwid OG, Halperin JM.

Does your child’s name predict ADHD?

As if parents didn’t have enough to feel guilty about, a study out of Israel suggests that a child’s name may correlate with subsequent hyperactivity. Here’s the abstract:

Background: The role of the meaning of given names has been noted in psychotherapy as well as in everyday life. This study aimed to investigate the possible association between the nature of given names of children and attention deficit hyperactivity disorder(ADHD) diagnosis. Sampling and Methods: A total of 134 given names of children and adolescent patients diagnosed as havingADHD were compared with those of an age- and gender-matched randomly chosen control group from the general population. The first names of the two cohorts were compared with regard to the following: the literal meaning of their names, whether the name constitutes a verb, the prevalence of each name and their length (number of syllables). Results: The meaning of first names of children and adolescents with ADHD combined type were rated by referees as expressing significantly more activity and containing less syllables than the names of controls. In addition, the prevalence of their names was significantly lower than that of names used in the general population. All findings remained significant following Bonferroni adjustment. Conclusions: Our findings demonstrate an intriguing relationship between children’s given names and ADHD diagnosis. Given names may serve as a possible predictor of later diagnosis of ADHD. Clinicians should be more attentive to given names in the context of child psychiatric evaluation and therapy.

Reference:

Psychopathology. 2012 May 22;45(4):215-219. [Epub ahead of print]
Are Names of Children with Attention Deficit Hyperactivity Disorder More ‘Hyperactive’?
Shoval G, Manor I, Nahshoni E, Weizman A, Zalsman G.

And no, please don’t ask me whether changing your hyperactive child’s name would decrease their hyperactivity. I have no idea what to make of this study other than children don’t fall off trees, and perhaps hyperactive parents tend to appreciate active or unusual names more than their non-ADHD peers.

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Attentional performance in children and adolescents with tic disorder and co-occurring ADHD

Those of us who work with or parent children and adolescents with Tourette syndrome (TS) have often had to educate teachers how tics or any premonitory urges can distract a student from a lesson.  But we all “know” that it’s really any co-morbid Attention Deficit Hyperactivity Disorder (ADHD) that is the real “killer” on attention.  So… does TS really impact core attentional abilities or does a child with TS have the same attention ability as any “normal” child who might be distracted while having hiccups?

A study by researchers in Germany suggests that TS does not impair core attentional abilities and that, TS by itself (“pure TS) may actually confer some benefit:

The aim of the present study was to investigate the effect of both tic disorder (TD) and attention-deficit/hyperactivity disorder (ADHD) on attentional functions. N=96 children and adolescents participated in the study, including n=21 subjects with TD, n=23 subjects with ADHD, n=25 subjects with TD+ADHD, and n=27 controls. Attentional performance was tested based on four computerized attention tasks (sustained attention, divided attention, go/nogo and set shifting). The effect of TD as well as ADHD on attentional performance was tested using a 2 × 2 factorial approach. A diagnosis of TD had no negative impact on attentional functions but was associated with improved performance in the set shifting task. By contrast, regardless of a diagnosis of TD, subjects with ADHD were found to perform worse in the sustained attention, divided attention and go/nogo task. No interaction effect between the factors TD and ADHD was revealed for any of the attention measures. Our results add to findings from other areas of research, showing that in subjects with TD and ADHD, ADHD psychopathology is often the main source of impairment, whereas a diagnosis of TD has little or no impact on neuropsychological performance in most cases and even seems to be associated with adaptive mechanisms.

You can download the full article in .html or .pdf (free resource).

Reference

Greimel E, Wanderer S, Rothenberger A, Herpertz-Dahlmann B, Konrad K, Roessner V. Attentional performance in children and adolescents with tic disorder and co-occurring attention-deficit/hyperactivity disorder: new insights from a 2 × 2 factorial design study. J Abnorm Child Psychol.2011 Aug;39(6):819-28.

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