Sensory Processing Differences in Children Diagnosed With Tourette's Disorder

The objectives of this research were to determine whether sensory processing differences existed in children between the ages of 5 and 10 years diagnosed with Tourette's disorder and to examine whether further differences existed if these children had an additional diagnosis of Attention Deficit Hyperactivity Disorder. The Short Sensory Profile was completed by caregivers for 75 children with Tourette's disorder, 47 who were also diagnosed with Attention Deficit Hyperactivity Disorder. Differences in sensory processing were identified in the total sample. More significant differences were found in the group of children with dual diagnoses, especially in the area of auditory processing.     

Psychosocial correlates of learning disability subtypes in children with tourette's syndrome

Children with different types of learning disabilities are thought to be at risk for specific profiles of behavior problems. This study sought to determine if learning disabilities are related to behavioral adjustment specifically in children with Tourette's syndrome (TS). We examined the Child Behavior Checklist (CBC) profiles of 61 children with TS who were between the ages of 6 and 18 years. The children were classified into one of three subtypes of learning disabilities or a nondisabled control group, based on performance on the Wide Range Achievement Test-Revised. Children with learning disabilities displayed higher scale elevations on the CBC than did controls, but not after controlling for the presence of attention deficit disorder. The results are inconsistent with previous research on the behavioral adjustment of subtypes of learning disabilities. Thus, the expression of learning disabilities may be idiosyncratic in children with discrete neuropsychiatric disorders such as TS.     

An Empirical Examination of Symptom Substitution Associated With Behavior Therapy for Tourette's Disorder

Over the past six decades, behavior therapy has been a major contributor to the development of evidence-based psychotherapy treatments. However, a long-standing concern with behavior therapy among many nonbehavioral clinicians has been the potential risk for symptom substitution. Few studies have been conducted to evaluate symptom substitution in response to behavioral treatments, largely due to measurement and definitional challenges associated with treated psychiatric symptoms. Given the overt motor and vocal tics associated with Tourette’s disorder, it presents an excellent opportunity to empirically evaluate the potential risk for symptom substitution associated with behavior therapy. The present study examined the possible presence of symptom substitution using four methods: (a) the onset of new tic symptoms, (b) the occurrence of adverse events, (c) change in tic medications, and (d) worsening of co-occurring psychiatric symptoms. Two hundred twenty-eight participants with Tourette’s disorder or persistent motor or vocal tic disorders were randomly assigned to receive behavioral therapy or supportive therapy for tics. Both therapies consisted of eight sessions over 10 weeks. Results indicated that participants treated with behavior therapy were not more likely to have an onset of new tic symptoms, experience adverse events, increase tic medications, or have an exacerbation in co-occurring psychiatric symptoms relative to participants treated with supportive therapy. Further analysis suggested that the emergence of new tics was attributed with the normal waxing and waning nature of Tourette’s disorder. Findings provide empirical support to counter the long-standing concern of symptom substitution in response to behavior therapy for individuals with Tourette's disorder.     

Short therapy of a child with Gilles de la Tourette's Syndrome*

This paper describes a three-hour intervention with a family whose younger son, aged four, was brought for consultation for Gilles de la Tourette's syndrome. The theoretical elaboration of the intervention is discussed so as to elucidate the therapeutic effect of the session leading to the lasting eradication of the symptoms.     

Support for Returning to Work for a Patient of Social Behavior Disorder with Impaired Self-awareness

Social behavioral disorders and impaired self-awareness, which are sequelae of brain injuries, have negative effects on interpersonal relationships and employment. In this study, we performed a long-term client-centered approach to help the patient diagnosed with a social behavior disorder and impaired self-awareness return to work. Cognitive rehabilitation, cognitive-behavioral treatment, and positive behavioral support were provided while assessing the self-awareness using the Japanese version of the Self-Regulation Skills Interview. This patient exemplifies the importance of establishing methods for self-monitoring and rebuilding a positive self-identity while considering the complexities of self-awareness when helping patients with impaired self-awareness. The patient took the initiative in managing problematic behaviors due to social behavior disorder, and as a result, was able to achieve stable self-awareness. The strategies described in this patient can be used in the future to treat patients with social behavior disorder due to inadequate self-awareness. In order to practice a client-centered approach while assessing the patient's level of self-awareness, it is important to build a trusting relationship over a long period. To assess the level of self-awareness, existing interviews, questionnaires, and work to express one's mental and physical state as seen by the patient may be effective.

     

Intervention response among preschoolers with ADHD: The role of emotion understanding

Emotion recognition/understanding (ERU), which is the ability to correctly identify emotional states in others as well as one's self, plays a key role in children's social-emotional development and is often targeted in early intervention programs. Yet the extent to which young children's ERU predicts their intervention response remains unclear. The current study examined the extent to which initial levels of ERU and changes in ERU predicted intervention response to a multimodal early intervention program (Summer Treatment Program for Pre-Kindergarteners; STP-PreK). Participants included 230 young children (M_age = 4.90, 80.0% male) with attention-deficit/hyperactivity disorder (ADHD) who participated in the 8-week STP-PreK. Children's ERU was measured via a standardized behavioral task. Similarly, standardized measures of academic achievement (Woodcock-Johnson-IV), executive functioning (Head-Toes-Knees-Shoulders-Task), and social-emotional functioning (Challenging Situation Task) were obtained pre- and post-intervention. Parents and teachers also reported on children's behavioral functioning pre- and post-intervention. Children with better initial ERU made greater improvements in academic, executive functioning (EF), and social-emotional domains, along with decreases in inattention symptom severity. However, pre-intervention levels of ERU were not associated with improvements in parent/teacher report of hyperactivity, oppositional defiant disorder, and overall behavioral impairment. Lastly, changes in ERU only predicted improvement in EF, but not any other school readiness outcomes. We provide preliminary evidence that initial levels of ERU predict intervention response across school readiness domains in a sample of preschoolers with ADHD.     

Teaching behavior analysts in an early intensive behavioral intervention setting to conduct a structured mealtime protocol

Children with autism spectrum disorder often display feeding problems, such as consumption of a limited variety of foods. It is also common for these children to be enrolled in early intensive behavioral intervention (EIBI) services for comprehensive treatment. Combined, these factors make it possible that behavior analysts will have a role in a child's clinical care related to feeding. However, given that the etiology of pediatric feeding disorders is complex and multifactorial, clinicians should ensure they have sufficient training and a setting that is appropriate for assessment and treatment. Therefore, we evaluated the effects of behavioral skills training in an EIBI setting to conduct a structured mealtime protocol. Training resulted in increases in procedural integrity, and we replicated these effects for all participants.     

Understanding and Treating Social Phobia

Social phobia, a relatively obscure disorder, is receiving increased attention due to evidence suggesting that it is more prevalent and debilitative than once thought. The purpose of this article is to help counselors better understand the nature of and treatments for this disorder. Effective behavioral and pharmacological approaches are reviewed, and counseling implications are discussed to increase counselors' confidence in providing treatment to people with social phobia.     

Benefits of Including Siblings in the Treatment of Autism Spectrum Disorders

Having a brother or sister with an autism spectrum disorder (ASD) can significantly impact the life of a typically developing sibling. These relationships are generally characterized by less frequent and nurturing interactions than are evident in sibling constellations with neurotypical children or children with other developmental disabilities. One way to address this issue is to teach typically developing siblings skills to participate in a brother or sister's treatment. Including siblings in behavioral interventions is documented to be beneficial to both children, and is associated with generalization of skills for the sibling with ASD. Here we review this body of literature, present case examples from clinical practice, and make treatment recommendations for utilizing sibling-mediated behavioral approaches.     

A Cognitive-Behavioural Treatment Programme for Conduct Disorder: The Case of Tumeleng

This article presents a case study of a teenager with conduct disorder (CD) using a cognitive-behavioural treatment programme for anger and aggression. Unique features of the case included comorbid expressive language disorder and a history of multiple traumatic brain injuries, and a Tswana (Botswana) ethnic/cultural background. Indications for successful treatment were the participant's intrinsic motivation to change and be accepted by his peers, and his good memory. Factors that contraindicated successful treatment were the absence of his parents, due to his attending boarding school and comorbidity. The case provides evidence for the efficacy of cognitive behavioral therapy (CBT) for CD in an adolescent of a Tswana background with comorbid expressive language disorder and history of multiple head injuries.     

ANALYZING THE INFLUENCE OF TIC‐RELATED TALK ON VOCAL AND MOTOR TICS IN CHILDREN WITH TOURETTE'S SYNDROME

This study examined the effect of tic‐related talk on the vocal and motor tics of 2 boys with Tourette's syndrome. Using ABAB withdrawal designs, the boys were alternately exposed to conditions with and without talk of their tics. For both boys, vocal tics markedly increased when talk pertained to tics and decreased when talk did not pertain to tics, but motor tic covariance was less consistent.     

Augmenting Diaphragmatic Breathing With Behavioral Exposure: Single-Case Experimental Design for Rumination Disorder

ObjectiveRumination disorder (RD) is a feeding/eating disorder and disorder of gut-brain interaction characterized by repeated, effortless regurgitations. Diaphragmatic breathing is the most widely used treatment technique for RD, theoretically as a competing response to the habitual contraction of the abdominal wall. However, in light of diaphragmatic breathing’s lack of effectiveness for some patients, we created a comprehensive treatment to test the incremental effect of behavioral exposure on symptom change.MethodIn a single-case experimental design, we present the treatment of a 27-year-old patient with a 9-year history of untreated RD. The patient completed a comprehensive six-session cognitive-behavioral treatment for RD, comprising a 1-week phase of self-monitoring regurgitations + psychoeducation (Phase A), a 6-week phase of diaphragmatic breathing (+ identification of secondary maintenance mechanisms) (Phase B), and a 3-week phase of diaphragmatic breathing + behavioral exposure (Phase C). We compared change in daily symptom data between Phases B and C, and also report 20-month follow-up data.ResultsThe patient’s daily regurgitation frequency did not change during Phase B (diaphragmatic breathing alone), even with the elimination of foods that had become associated with regurgitations. However, she achieved a significant reduction in regurgitations during Phase C, with symptom remission extending to 20-month follow-up. Phase C included purposefully breaking learned associations with food stimuli using behavioral exposure.ConclusionsOur data suggest that when diaphragmatic breathing alone is not effective in reducing symptoms, further cognitive and behavioral techniques like behavioral exposure can augment the effect of diaphragmatic breathing on symptom reduction.     

Impact of personality disorders on treatment outcome for female assault survivors with chronic posttraumatic stress disorder

This study examined the impact of comorbid personality disorders on the outcome of cognitive behavioral treatment for women with chronic posttraumatic stress disorder (PTSD). Seventy-five adult women with PTSD resulting from rape or nonsexual assault in adulthood or sexual abuse in childhood were treated with prolonged exposure with or without cognitive restructuring. Assessment of personality disorders found that 39% of participants met DSM-IV criteria for some personality disorder diagnosis. No difference was found between women with and without personality disorders on the prevalence of PTSD at the end of treatment. Participants with a personality disorder were less likely to attain good end-state functioning, but this may be attributable to the fact that they started off slightly worse than those without personality disorders. Finally, the comorbid patients treated by community therapists fared as well or better than those treated by cognitive behavioral treatment experts in posttreatment prevalence of PTSD and end-state functioning.     

Cognitive-Behavioral Therapy for Adolescent Body Dysmorphic Disorder

The onset of appearance-related concerns associated with body dysmorphic disorder (BDD) typically occurs in adolescence, and these concerns are often severe enough to interfere with normal development and psychosocial functioning. Cognitive behavioral therapy (CBT) is an effective treatment for adults with BDD. However, no treatment studies focusing on adolescents with BDD have been conducted. The need for an effective treatment in this population led to the development of a brief CBT protocol with family involvement. The treatment focuses on enhancing an adolescent's quality of life through the reduction of maladaptive thoughts and behaviors, and incorporates skills training and parent training. Similar treatment packages have already been shown to be efficacious for children and adolescents with similar disorders, such as obsessive-compulsive disorder and social phobia. The following case illustrates the application of this brief CBT protocol for BDD in an adolescent, and highlights clinical considerations needed when adapting CBT for a pediatric population. Treatment was associated with clinically significant improvement in symptoms of BDD, self-esteem, depression, and quality of life. This report extends extant literature by suggesting that CBT may be a helpful treatment for adolescents with BDD.     

Behavior Therapy for Tics via Videoconference Delivery: An Initial Pilot Test in Children

Habit reversal training (HRT) has been proven effective for reducing tics in children with Tourette's syndrome (TS). However, the availability of the intervention is limited. Videoconference technology represents a promising mode through which HRT may be disseminated to underserved areas. Using a multiple-baseline across participants design, the current study tested the effectiveness of videoconference-delivered HRT for 3 children with TS. Similar to results from randomized controlled trials studying face-to-face delivered HRT, videoconference-delivered HRT was effective for reducing tics. All three children demonstrated significant tic reduction following videoconference HRT delivery. All participants and their families rated the delivery modality as acceptable and the therapeutic relationship as strong. These results suggest that videoconference delivery may be a promising method for disseminating behavior therapy for tics.     

DISCRIMINATION LEARNING IN ADULTS WITH NEUROCOGNITIVE DISORDERS

Alzheimer's disease is the most commonly known neurocognitive disorder characterized by deterioration in areas such as memory, attention, and activities of daily living. From a behavioral perspective, memory and attentional deficits may be described as deterioration of stimulus control. This paper provides a case study of discrimination behavior in a patient with neurocognitive disorder. The purpose of the current study was twofold: (i) to study the effect of using presumed familiar pictures in arbitrary matching‐to‐sample tasks and (ii) to study variables that affect stimulus control in a patient diagnosed with vascular dementia. There were 12 conditional discrimination experimental conditions with various types of stimuli, from familiar pictures to identity matching. The results showed that the participant's responses were not in accord with experimenter‐defined stimulus classes when using familiar pictures. However, intact stimulus control by sample stimulus was established following systematic procedural changes in the conditional discrimination tasks. Copyright © 2014 John Wiley & Sons, Ltd.     

The Association Between Self-Control and Hoarding: A Case Report

The capacity to exert control over one's behavior is known as self-control, and this ability to self-regulate is a necessary component for directing personal behavior toward achieving a specific goal. Baumeister and colleagues have suggested that self-control operates within a resource model such that an individual may strengthen this resource through directed practice. Hoarding is one syndrome wherein self-control may play a substantial role. Within a translational research framework, two separate case studies sought to determine if practicing self-control in a non-hoarding-related domain might have an impact on an individual's hoarding symptoms and their readiness for treatment. Two individuals diagnosed with hoarding were enrolled in a self-control practice condition. Both self-control levels and hoarding symptoms were measured at pre– and post–time points using self-report and behavioral indices. Findings in support of a favorable effect of self-control on mitigating behavioral hoarding symptoms were mixed, with 1 patient experiencing marked improvement in symptoms and the other not. We also found that self-control practice was associated with both increased motivation for treatment and overall level of self-awareness. The implications of self-control for hoarding are discussed from a disease-reduction and prevention standpoint, along with the role self-control might play within more traditional cognitive behavioral interventions.