Children with Tourette syndrome at greater risk of peer victimization

Back in 2005, I published a study that included some parental reports on peer harassment and victimization in children with Tourette syndrome. Respondents in that survey indicated that 28% of their children experienced peer rejection associated with their TS.  Subsequently, a few more controlled studies have appeared that confirm my report:  children with Tourette syndrome (TS) are at increased risk of peer victimization. Here’s the abstract of a recent study that attempted to correlate victimization with different aspects of TS:

Chronic tic disorders including Tourette syndrome have negative impact across multiple functional domains. We explored associations between peer victimization status and tic subtypes, premonitory urges, internalizing symptoms, explosive outbursts, and quality of life among youth with chronic tic disorders, as part of the internet-based omnibus Tourette Syndrome Impact Survey. A mixed methods design combined child self-report and parental proxy-report (i.e., parent reporting on the child) demographic and quantitative data for affected youth ages 10-17 years addressing gender, mean age, ethnicity and other socioeconomic features, and presence of tic disorders and co-occurring psychiatric disorders. Peer “Victim” versus “Non-victim” status was determined using a subset of four questions about being bullied. “Victim” status was identified for those youth who endorsed the frequency of the occurrence of being bullied in one or more of the four questions as “most of the time” or “all of the time”. Data from 211 eligible youth respondents and their parents/guardians showed 26% reporting peer victimization. Victim status was associated with greater tic frequency, complexity and severity; explosive outbursts; internalizing symptoms; and lower quality of life. Peer victimization among youth with chronic tic disorders is common and appears associated with tic morbidity, anxiety, depression, explosive outbursts, and poorer psychosocial functioning. Anticipatory guidance, specific bullying screening and prevention, and further studies are indicated in this population.

The full study was published in the August 31 issue of Child Psychiatry and Human Development.  And yes, further studies are needed to help clarify questions such as which comes first – the victimization or the explosive outbursts?  The poorer psychosocial functioning or the victimization?

 

Correlates of tic disorders in school-age Danish children

A new study of Danish school children looked at children with chronic tic disorders (CTD):  Tourette syndrome (TS) and Chronic Motor Tics Disorder (CMT).  Key comorbidity findings (from their abstract):

• Approximately one-third of those with a chronic tic disorder reported remission of tics by age 13-15.
• On the parent-rated Strengths and Difficulties Questionnaire, children with a CTD were 5 times more likely to fall into the clinical range of hyperactivity, 2 times as likely to exhibit disruptive and defiant behavior and over 4 times more likely to have emotional difficulties compared to children without tic disorders.
• Children with hyperactivity and CTD were more impaired than subjects with CTD only. Children with CTD and hyperactivity show greater symptom severity across several domains of behavior and overall impairment.
• In the absence of hyperactivity, children with CTD are at increased risk for emotional difficulties, but not disruptive behavior problems.

The full study was published in the October 27 issue of European Child & Adolescent Psychiatry.

Sensitivity to external stimulation in Tourette syndrome

One common observation in working with children and adults with Tourette syndrome (TS) is that they often have what appears to be a heightened sensitivity to the environment.  An interesting study was published in the October 28 issue of Movement Disorders that looks at this issue. Here’s the Abstract:

… In this study (1) we defined the patients’ experience of sensitivity to external stimuli in detail, and (2) we tested 2 hypotheses regarding its origin. First, we interviewed in depth and administered a lengthy questionnaire to adult Tourette patients (n = 19) and age-matched healthy volunteers (n = 19). Eighty percent of patients described heightened sensitivity to external stimuli, with examples among all 5 sensory modalities. Bothersome stimuli were characterized as faint, repetitive or constant, and nonsalient, whereas intense stimuli were well tolerated. We then determined whether the sensitivity could be the result of an increased ability to detect faint stimuli. After measuring the threshold of detection for olfactory and tactile stimuli among the patients and healthy volunteers, we found no significant differences between them for either sensory modality. These results indicate that patients’ perceived sensitivity derives from altered central processing rather than enhanced peripheral detection. Last, we assessed one aspect of processing: the perception of intensity. When subjects rated the intensity of near-threshold tactile and olfactory stimuli, there was a surprising difference: Tourette patients more frequently used the lowest range of the scale than did healthy volunteers. Future research is necessary to define the anatomical and physiological basis of the patients’ experience of heightened sensitivity.

So what does this mean? It seems that individuals with TS do not have an enhanced ability to detect mild sensory stimulation and recognize it as mild – they are just more bothered by it?  If so, that might help explain some of the distractibility and irritation individuals with TS often report. Imagine if you were sitting in a classroom and the soft thumping of a motor in a nearby room was driving you crazy – even though no one else seemed to be bothered by it…

I have occasionally recommended that parents of my young patients take them to an occupational therapist for a sensory integration evaluation. This study, while raising as many questions as it answers, offers some confirmation to my thinking that we need to pay much more attention to the sensory aspects of TS – both the internal urges (prodromes) and the heightened reactivity to external stimuli.

Of Tics and Compulsions: Brain Imaging Teases Apart Tourette’s and Obsessive-Compulsive Disorder

Anyone who has parented, taught, or treated individuals with both Tourette syndrome (TS) and Obsessive-Compulsive Disorder (OCD) knows how difficult it can be at times to tease out whether something is a complex tic or a compulsion.  Can brain imaging help us?  Melinda Wenner Moyer writes in the September issue Scientific American:

… Now a new study published in Neurology may help scientists further understand how the disorders overlap and differ by revealing several key differences in the brain activity of Tourette’s patients with and without OCD.

Andrew Feigin and his colleagues at North Shore LIJ Health System in Manhasset, N.Y., scanned the brains of 12 unmedicated Tourette’s patients—some of whom also had OCD—and 12 healthy subjects using positron-emission tomography, which reveals patterns of brain activity. Compared with healthy controls, those who had Tourette’s exhibited more activity in the premotor cortex and cerebellum, regions that handle motor control, and less activity in the striatum and orbitofrontal cortex, areas involved in decision making and learning. These findings support the idea that the symptoms of the disorder may arise from the brain’s inability to suppress abnormal actions using decision-making skills.

When the researchers compared the Tourette’s patients who had OCD with those who did not, they found that the patients who had both disorders exhibited greater activity in the primary motor cortex and precuneus, an area that plays a role in self-awareness. Previous research has suggested that in patients who suffer from both disorders, OCD might show up more in the form of compulsions than obsessions, and these findings support that idea: the increased activity of the precuneus may reflect individuals’ efforts and ability to resist obsessive thought, and the motor cortex may be more active because OCD is manifesting itself more physically than mentally.

 

The full article is only available to those who subscribe to or have access to Scientific American

New Documentary on Tourette Syndrome to Premier Thursday, September 15th

The Brad Cohen Tourette Foundation sent out this announcement:

Different is the New Normal will premier on Thursday, September 15th at 8pm (EST) on THIRTEEN (WNET, public television in NY) and then again on Saturday, September 17th at 3:30am (EST)

It will air on Tuesday, September 20th at 10 pm (EST) on NJTV (public television in NJ) then again Thursday, September 22nd at 4 am (EST), Sunday, September 25th at 5 am (EST) ) and Sunday, September 25th at 11 pm (EST), Tuesday, September 27th at 10:30 pm (EST) on WLIW21 (public television in metropolitan and suburban NYC and NJ)

After the broadcast, it will be on this website for a limited time: http://watch.thirteen.org/

The one hour film is about the life of Chicago native Ariel Small, a teen with Tourette Syndrome who inspires others living with TS to be the best they can be. American Idol star James Durbin makes an appearance as he discusses how he has overcome TS himself. This show is informational, educational, and an honest portrayal of what life is like for someone with TS. Follow one kids journey to be normal and accepted by others and how he became empowered to educate the world about TS.

“Different Is the New Normal captures the pain and frustration many parents and their children experience,” said Neal Shapiro, WNET’s President and CEO. “Ariel’s inspirational story provides an uplifting perspective to this often misunderstood disorder, and will inspire everyone who watches this film to think about people as individuals, not as labels.”

Just like my story, Ariel Small will show America that just because a person has TS, we don’t have to allow TS to win. This inspirational show is nicely done and without a doubt will help others understand what living with TS is all about. I give it two thumbs up and after viewing it, I think you do the same.

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