The effects of co‐occurring ADHD symptoms on electrophysiological correlates of cognitive control in young people with Tourette syndrome

Efficient cognitive control is implicated in tic control in young people with Tourette syndrome (TS). Attention‐deficit/hyperactivity disorder (ADHD) frequently co‐occurs with TS and is associated with impaired cognitive control. Young people with TS and ADHD (TS+ADHD) show poorer cognitive control performance than those with TS, but how co‐occurring ADHD affects underlying neural activity is unknown. We investigated this issue by examining behavioural and event‐related potential (ERP) correlates of cognitive control in young people with these conditions. Participants aged 9–17 with TS (n = 17), TS+ADHD (n = 17), ADHD (n = 11), and unaffected controls (n = 20) performed a visual Go/Nogo task during electroencephalography (EEG) recording. Behavioural performance measures (D‐prime, RT, reaction time variability, post‐error slowing) and ERP measures (N2, P3, error‐related negativity (ERN), error positivity (Pe)) were analysed in a 2 (TS‐yes, TS‐no) × 2 (ADHD‐yes, ADHD‐no) factorial analysis to investigate the effects of TS, ADHD, and their interaction. The results of these analyses showed that ADHD was associated with poorer performance and reduced amplitude of all ERPs, reflecting widespread cognitive control impairments. Tourette syndrome was associated with slowed RTs, which might reflect a compensatory slowing of motor output to facilitate tic control. There was no interaction between the TS and ADHD factors for any behavioural or ERP measure, indicating the impairing effects of ADHD on behaviour and electrophysiological markers of cognitive control were present in TS+ADHD and that RT slowing associated with TS was unaffected by co‐occurring ADHD symptoms.     

Examining the neural antecedents of tics in Tourette syndrome using electroencephalography

Tourette syndrome (TS) is a neurodevelopmental disorder characterized by the occurrence of motor and vocal tics. TS is associated with cortical–striatal–thalamic–cortical circuit dysfunction and hyper-excitability of cortical limbic and motor regions that lead to the occurrence of tics. Importantly, individuals with TS often report that their tics are preceded by premonitory sensory/urge phenomena (PU) that are described as uncomfortable bodily sensations that precede the execution of a tic and are experienced as an urge for motor discharge. While tics are most often referred to as involuntary movements, it has been argued by some that tics should be viewed as voluntary movements that are executed in response to the presence of PU. To investigate this issue further, we conducted a study using electroencephalography (EEG). We recorded movement-related EEG (mu- and beta-band oscillations) during (1) the immediate period leading up to the execution of voluntary movements by a group of individuals with TS and a group of matched healthy control participants, and (2) the immediate period leading up to the execution of a tic in a group of individuals with TS. We demonstrate that movement-related mu and beta oscillations are not reliably observed prior to tics in individuals with TS. We interpret this effect as reflecting the greater involvement of a network of brain areas, including the insular and cingulate cortices, the basal ganglia and the cerebellum, in the generation of tics in TS. We also show that beta-band desynchronization does occur when individuals with TS initiate voluntary movements, but, in contrast to healthy controls, desynchronization of mu-band oscillations is not observed during the execution of voluntary movements for individuals with TS. We interpret this finding as reflecting a dysfunction of physiological inhibition in TS, thereby contributing to an impaired ability to suppress neuronal populations that may compete with movement preparation processes.     

Hypothesizing, Circularity, and Neutrality Revisited: An Invitation to Curiosity

This essay examines the systemic guiding principles of neutrality, hypothesizing, and circularity, historically developed by the Milan Team of Selvini-Palazzoli, Boscolo, Cecchin, and Prata (12, 13). With the reorganization of these team members (see 11 for a summary of the distinctions between the work of the Selvini-Palazzoli and Prata research team and the Cecchin and Boscolo training team), different reconstructions of the original systemic principles have evolved. New understanding of the concepts of circularity, hypothesizing, and neutrality are now possible, given the systemic epistemology on which the early Milan model was based. It should be emphasized, however, that the ideas presented in this essay are most associated with the systemic work of the Cecchin and Boscolo team.     

Book reviews

Beth Haasl and Jean Marnocha, Bereavement Support Group Program for Children
Giuliana Prata, A Systemic Harpoon into Family Games: Preventive Interventions into Therapy
Robert Wilkins, Behaviour Problems in Children – Orthodox and Paradox in Therapy     

Habit reversal treatment: Learning an incompatible response or increasing the subject's awareness?

The elements of the Habit Reversal Treatment Package developed by Azrin and Nunn (1973) to counteract nervous habits were systematically analysed. Fifty nail biters (92% reported biting their nails for more than 5 yr) were randomly assigned to one of the following treatments: Habit Reversal, Habit Reversal and Self-Monitoring, Self-Monitoring, Self-Monitoring and Daily Graph Plotting, Waiting List control, Pictures of both hands were taken prior to the commencement of treatment and at 6 and 12 weeks after treatment termination. The results showed that the four treatment groups improved equally compared with the control subjects. Such data cast doubt on the importance of learning an incompatible response in Habit Reversal Treatment. An alternative explanation based on increasing the subject's awareness is put forward.     

Inhibition of Return in children with Tourette's syndrome and comorbid forms: A Preliminary Study

Background: This study investigated the nature and functioning of the visual-spatial inhibition of return (IOR) phenomenon in children with “pure” Tourette's syndrome (TS), and those with comorbid forms of TS. Method: Children with TS-only and “TS + comorbid” (TS + ADHD +/- OCD) and matched controls performed the inhibition of return (IOR) task, which involved responding to left and right visual targets appearing on a computer screen that were preceded by congruent or incongruent exogenous visual cues. Results: The TS-only group performed similarly on the IOR task to the controls. When the TS-only group was subdivided into children with mild and severe TS symptoms, a post hoc comparison between the controls and severe TS symptom children revealed that these TS children had a reduced magnitude of IOR for targets appearing in the right visual field. The comparison between the TS + comorbid and controls revealed an atypical IOR pattern for the TS + comorbid group. They displayed a loss of normal facilitatory and inhibitory effects for right visual field targets. Conclusions: The findings suggest abnormalities in attentional “disengage” and “move” mechanisms in TS when directing attention to the right visual field, which may reflect left posterior parietal, superior colliculus, and midbrain pathology.     

Neonatal tactile stimulation enhances spatial working memory, prefrontal long-term potentiation, and D1 receptor activation in adult rats

Environmental stimuli during neonatal periods play an important role in the development of cognitive function. In this study, we examined the long-term effects of neonatal tactile stimulation (TS) on spatial working memory (SWM) and related mechanisms. We also investigated whether TS-induced effects could be counteracted by repeated short periods of maternal separation (MS). Wistar rat pups submitted to TS were handled and marked transiently per day during postnatal days 2–9 or 10–17. TS/MS pups were stimulated in the same way as TS pups and then individually separated from their mother for 1 h/day. Their nontactile stimulated (NTS) siblings served as controls. In adulthood, TS and TS/MS rats showed better performance in two versions of the delayed alternation task and superior in vivo long-term potentiation of the hippocampo–prefrontal cortical pathway when compared with controls. Furthermore, there were more doses of A77636 (a selective dopamine D1 agonist) to significantly improve SWM performance in TS and TS/MS rats than in NTS rats, suggesting that activation of prefrontal D1 receptors in TS and TS/MS rats is more optimal for SWM function than in NTS rats. MS did not counteract TS-induced effects because no significant difference was found between TS/MS and TS animals. These data indicate that in early life, external tactile stimulation leads to long-term facilitative effects in SWM-related neural function.     

Masculinity,Femininity, and Multiple Regression: A Reply to Holmbeck

We respond to Holmbeck's (this issue) criticism of our work. Holmbeck is correct to observe that we mislabel the hierarchical regression analyses that we actually performed in Zeldow et al. (1985, 1987) as stepwise regressions. We also reported some correlation coefficients in Zeldow et al. (1985) which were incorrect. However, further speculation by Holmbeck that alternate analyses would "dramatically" alter our results and that we are guilty of various interpretive errors are shown to be wrong. Most of Holmbeck's conclusions about the potential misuses of multiple regression analyses in androgyny research are supported. However, the substantive conclusions of our earlier articles remain unchanged.     

The effect of semantic ambiguity on reading aloud: A twist in the tale

Despite numerous studies investigating whether semantic representations are involved in the process of reading aloud, the issue remains controversial. While some studies report significant effects of semantic variables on this task (e.g., Fera, Joordens, Balota, Ferraro, & Besner, 1992; Strain, Patterson, & Seidenberg, 1995), other studies have highlighted possible problems with these studies (e.g., Borowsky & Masson, 1996; Monaghan & Ellis, 2002). The experiments reported here use semantic ambiguity as a marker for semantic involvement and confirm that semantic representations can indeed affect reading aloud, but that the size of semantic effects is influenced by the consistency of the words and the speed with which participants respond.     

Testing clinical hypotheses by means of "falsificationist epistemology"

A family therapist using the "falsificationist epistemology" can, during the first session, test the hypotheses formulated on the telephone intake chart and also gather further information to reexamine and redefine these hypotheses. We shall examine a case treated by Dr. G. Prata, analyzing the most important phases of the first session, and stressing what methodological and tactical choices were designed to test the leading hypothesis of the "game" played by this family.     

Issues in Factor-Analyzing Ipsative Measures: The Learning Style Inventory (LSI-1985) Example

This paper reviews the statistical issues in factor analyzing ipsative measures and then illustrates the issue using ipsative data from Kolb's revised Learning Style Inventory (LSI-1985) and Dunlap & Cronwell's (1994) recommended procedures. The statistical findings underscore the problem of determining the valid underlying factor structure of ipsative measures.     

Masculinity,Femininity, and Multiple Regression: Comment on Zeldow,Daugherty, and Clark's "Masculinity,Femininity, and Psychosocial Adjustment in Medical Students: A 2-Year Follow-Up"

Inappropriate applications and interpretations of multiple regression analyses by Zeldow and his associates (Zeldow, Clark, & Daugherty, 1985; Zeldow, Daugherty, & Clark, 1987) are discussed as are several general interpretive and statistical issue. To perform and interpret multiple regressors, several characteristics of this statistical approach must be taken into account. Of critical importance is the order in which variables are entered, the choice of regression approaches, the direction of an effect upon entering the model, and the manner in which the interpretation of interaction effects varies as a function of the presence or absence of main effects. Because Zeldow et al. (1985, 1987) did not consider these factors, their regression analyses were not run as stated and are difficult to interpret. Five hypothetical outcomes in androgyny research and an example involving actual data are presented.     

Femininity discovered: Dreams of two women

[For reasons of space and because Ms Gerry's “Testament” was written with friends especially in mind, the original text has been abridged with the approval of Mary Nunn, executor of Ms Gerry's literary estate-Ed.]

[Peggy Gerry's life ended June 13, 1976-Ed.]     

APPLYING BEHAVIOR ANALYSIS TO CLINICAL PROBLEMS: REVIEW AND ANALYSIS OF HABIT REVERSAL

This article provides a review and analysis of habit reversal, a multicomponent procedure developed by Azrin and Nunn (1973, 1974) for the treatment of nervous habits, tics, and stuttering. The article starts with a discussion of the behaviors treated with habit reversal, behavioral covariation among habits, and functional analysis and assessment of habits. Research on habit reversal and simplified versions of the procedure is then described. Next the article discusses the limitations of habit reversal and the evidence for its generality. The article concludes with an analysis of the behavioral processes involved in habit reversal and suggestions for future research.     

Implicit sequence learning in young people with Tourette syndrome with and without co-occurring attention-deficit/hyperactivity disorder

Impaired habit-learning has been proposed to underlie the tic symptoms of Tourette syndrome (TS). However, accounts differ in terms of how habit-learning is altered in TS, with some authors proposing habit formation is impaired due to a deficient ‘chunking’ mechanism, and others proposing habit-learning is overactive and tics reflect hyperlearned behaviours. Attention-deficit/hyperactivity disorder (ADHD) frequently co-occurs with TS and is known to affect cognitive function in young people with co-occurring TS and ADHD (TS + ADHD). It is unclear, however, how co-occurring ADHD symptoms affect habit-learning in TS. In this study, we investigated whether young people with TS would show deficient or hyperactive habit-learning, and assessed the effects of co-occurring ADHD symptoms on habit-learning in TS. Participants aged 9–17 years with TS (n = 18), TS + ADHD (n = 17), ADHD (n = 13), and typical development (n = 20) completed a motor sequence learning task to assess habit-learning. We used a 2 (TS-yes, TS-no) × 2 (ADHD-yes, ADHD-no) factorial analysis to test the effects of TS, ADHD, and their interaction on accuracy and reaction time indices of sequence learning. TS was associated with intact sequence learning, but a tendency for difficulty transitioning from sequenced to non-sequenced performance was suggestive of hyper-learning. ADHD was associated with significantly poorer accuracy during acquisition of the sequence, indicative of impaired habit-learning. There were no interactions between the TS and ADHD factors, indicating young people with TS + ADHD showed both TS- and ADHD-related atypicalities in habit-learning.     

Executive Functions in Children and Adolescents with Turner Syndrome: A Systematic Review and Meta-Analysis

Turner syndrome (TS) is a genetic disorder, affecting 1/2500 to 1/3000 live female births, induced by partial or total deletion of one X chromosome. The neurocognitive profile of girls with TS is characterized by a normal Verbal IQ and weaknesses in visual-spatial, mathematics, and social cognitive domains. Executive functions (EFs) impairments have also been reported in these young patients. However, methodological differences across studies do not allow determination of which EFs are impaired and what is the magnitude of these impairments. The aim of this review was to clarify the EF profile of children and adolescents with TS. Sixteen samples, from thirteen studies, were included in the current meta-analysis. EFs measures used in these studies were classified into working memory, inhibitory control, cognitive flexibility, or higher-order EFs tasks in accordance with Diamond’s model, Annual Review of Psychology, 64, 135–168 (2013). Results confirmed that girls with TS had significant executive impairments with effect sizes varying from small (inhibitory control) to medium (cognitive flexibility) and large (working memory, higher-order EFs). Analyses by task revealed that cognitive inhibition may be more impaired than the other inhibitory control abilities. Heterogeneity across cognitive flexibility measures was also highlighted. Between-sample heterogeneity was observed for three tasks and the impact of participants’ characteristics on EFs was discussed. This meta-analysis confirms the necessity to assess, in patients living with TS, each EF by combining both visual and verbal tasks. Results also underline that, when studying girls with TS’ executive profile, it is important to explore the impact of moderator variables, such as IQ, parental socio-economic status, TS karyotype, psychiatric comorbidities, and hormonal treatment status.     

Revisiting confidence intervals for repeated measures designs

Loftus and Masson (1994) proposed a method for computing confidence intervals (CIs) in repeated measures (RM) designs and later proposed that RM CIs for factorial designs should be based on number of observations rather than number of participants (Masson & Loftus, 2003). However, determining the correct number of observations for a particular effect can be complicated, given that its value depends on the relation between the effect and the overall design. To address this, we recently defined a general number-of-observations principle, explained why it obtains, and provided step-by-step instructions for constructing CIs for various effect types (Jarmasz & Hollands, 2009). In this note, we provide a brief summary of our approach.     

Turner syndrome: a review of genetic and hormonal influences on neuropsychological functioning.

Turner syndrome (TS) is a genetic disorder affecting mainly females that arises from a loss of X chromosome material, most usually one of the two X chromosomes. TS is associated with a number of characteristic physical features such as short stature and absent ovaries as well as a set of common neuropsychological deficits and social and behavioral features. This paper will serve to review the cognitive, social, and psychoeducational abilities of individuals with TS as well as neuroimaging findings. Several putative genetic mechanisms contributing to their particular neurocognitive deficits will also be described including candidate genes. In addition, the available evidence on how hormones affect specific abilities in TS will be reviewed. It will be concluded that the TS neurobehavioral profile arises from an atypical cerebral organization caused by the complex interplay of insufficient expression of certain (unknown) genes on the X chromosome and by abnormal hormonal levels; however, it is still not clear exactly how the specific genes affect broader cognitive abilities. Future research needs to identify the elemental processes that are disturbed in TS and map these both to events in early brain development and subsequent brain function and to specific gene and hormonal contributions.     

Priming effects that span an intervening unrelated word: implications for models of memory representation and retrieval.

Several studies have reported priming effects that span an intervening unrelated word (Davelaar & Coltheart, 1975; Meyer, Schvaneveldt, & Ruddy, 1972). More recently, other investigators have suggested that such relatedness effects are the result of postaccess processes (Gough, Alford, & Holley-Wilcox, 1981; Masson, 1991; Ratcliff & McKoon, 1988). In fact, these investigators claim that when procedures are used that discourage the use of postaccess processes, relatedness effects do not span intervening unrelated words. The present experiments demonstrate reliable relatedness effects with procedures that eliminate postaccess processes. These results are consistent with the notion of spreading activation among local representations in memory. Implications for the issue of local versus distributed representations are discussed.