Behavioral and pharmacological treatments for tourette syndrome: A review

This article reviews the published treatment outcome research on pharmacological and behavioral treatments for Gilles de la Tourette syndrome (TS). Controlled group outcome studies of pharmacological treatments show about a 50–60% reduction in tics with haloperidol and pimozide and about a 20% reduction with clonidine. A controlled group outcome study and several within-subject design studies of behavioral treatments show about a 90% reduction in tics with habit reversal training. A large number of case studies generally confirm these results and also show benefits from other behavioral treatments such as relaxation training, self-monitoring, and contingency management. Clinical limitations of TS drugs are that they produce side effects in 50–85% of the patients and require continuous use, and long-term compliance with the medications is limited. The primary limitation of behavioral treatments is that they require a large initial time commitment. The methodological strengths of the controlled drug studies are the use of double-blind and group designs. For the behavioral studies, the strengths are rigorous recording and controlled within-subject designs.     

Hostile attributional biases in severely aggressive adolescents

Adolescent boys (N = 128) from a maximum security prison for juvenile offenders were administered a task to assess hostile attributional biases. As hypothesized, these biases were positively correlated with undersocialized aggressive conduct disorder (as indicated by high scores on standardized scales and by psychiatric diagnoses), with reactive-aggressive behavior, and with the number of interpersonally violent crimes committed. Hostile attributional biases were found not to relate to nonviolent crimes or to socialized aggressive behavior disorder. These findings held even when race and estimates of intelligence and socioeconomic status were controlled. These findings suggest that within a population of juvenile offenders, attributional biases are implicated specifically in interpersonal reactive aggression that involves anger and not in socialized delinquency.     

Social skills of aggressive and nonaggressive adolescents

Abstract.— Forty 14-year-old boys were selected on the basis of peer ratings to represent characteristic aggressive, controlled extravert, anxious, and controlled introvert patterns of behaviour. Each boy was asked to play the role of either a son or a chum with the corresponding father's or chum's role played by the male E in four tape recorded dialogues. The topics were "getting more pocket money", "holiday making", "choosing a TV channel", and "agreeing on a favourite make of car". The boys' ability to persuade the opponent and to express their disagreement in a socially acceptable manner was studied. In accordance with the hypotheses the results showed that the controlled extraverts were sensible negotiators while the aggressive belittled the other's proposals and showed disagreement and indifference. The controlled introverts conformed passively and the anxious had signs of blocking in their speech. A discriminant analysis revealed that the differences were also very clear on the individual level.     

Depressive symptoms in Swedish adolescents

This study examined the prevalence of self-reported depressive symptoms in a Swedish urban school sample (n=547) aged 13 to 18 years using the Beck Depression Inventory (BDI). The data obtained were examined with respect to sex and age differences and compared with a clinical sample of adolescents hospitalized because of psychiatric disturbances. The results indicated a strong preponderance of depressive symptoms among girls in the school sample, in particular for the severe symptom level. Eight percent of subjects reported depressive symptoms sufficiently high to be classified as a moderate, and 2% as a severe, level of depression. Factor analysis yielded four factors representing dysphoric mood, social activity, relationship, and food-related dimensions. The BDI showed a high internal consistency, and test-retest reliability calculated for a 2-week and a 2-month interval revealed strong correlations. The means of total scores on the BDI for the clinical sample were significantly higher than for those in the school sample.     

Social acceptance and the relationship between aggressive problem-solving strategies and aggressive behaviour in 14-year-old adolescents

This study examines the relationship between aggressive problem-solving strategies and aggressive behaviour, and the intervening role of social acceptance in that relationship. The subjects were 780 14-year-old adolescents (382 girls and 398 boys). They completed a questionnaire measuring social problem-solving strategies, while assessments of aggressive behaviour and social acceptance were obtained by peer ratings. The results showed that aggressive problem-solving strategies were only moderately related to aggressive behaviour, social acceptance playing an important role. Those who received incongruent social feedback, i.e. scored high on social acceptance even though they behaved aggressively, or low although they behaved non-aggressively, expressed aggressive problem-solving strategies which conflicted with their actual behaviour. Those who received congruent social feedback, on the other hand, i.e. scored high on social acceptance if they behaved non-aggressively, or low if they behaved aggressively, had strategies which were in line with their actual aggressive behaviour. Analyses of gender differences showed that aggressive problem-solving strategies were related to aggressive behaviour and social acceptance more among boys. The findings are discussed in terms of social information-processing models and social knowledge about the self.     

Stress and coping in Japanese children and adolescents

Japanese children and adolescents (n=580) provided self-reports of stressor intensity, coping efforts, and adjustment. A new measure of Japanese adolescent coping was created, and psychometric analyses confirmed a reliable four-factor structure. Mean group difference analyses showed that girls reported higher levels of self-image and peer relations stress, and reported using isolation and problem-solving coping more and externalising coping less than males. Younger adolescents (5th/8th grades) reported higher stress in the domains of school, peer relations, and family relations, whereas older adolescents (10th grade) reported higher self-image problems. Statistical moderation was used to examine how youth negotiated the stress process. Females were found to be more responsive to appearance, family, and peer difficulties. Affiliation coping by females operated as a buffer between appearance anxiety and dissatisfaction with appearance. Externalizing coping was not associated with peer relations satisfaction for males, but it was negatively associated for females.     

Stress and coping in Japanese children and adolescents

Abstract

Japanese children and adolescents (n=580) provided self-reports of stressor intensity, coping efforts, and adjustment. A new measure of Japanese adolescent coping was created, and psychometric analyses confirmed a reliable four-factor structure. Mean group difference analyses showed that girls reported higher levels of self-image and peer relations stress, and reported using isolation and problem-solving coping more and externalising coping less than males. Younger adolescents (5th/8th grades) reported higher stress in the domains of school, peer relations, and family relations, whereas older adolescents (10th grade) reported higher self-image problems. Statistical moderation was used to examine how youth negotiated the stress process. Females were found to be more responsive to appearance, family, and peer difficulties. Affiliation coping by females operated as a buffer between appearance anxiety and dissatisfaction with appearance. Externalizing coping was not associated with peer relations satisfaction for males, but it was negatively associated for females.     

American adolescents touch each other less and are more aggressive toward their peers as compared with French adolescents

Forty adolescents were observed at McDonald's restaurants in Paris and Miami to assess the amount of touching and aggression during their peer interactions. The American adolescents spent less time leaning against, stroking, kissing, and hugging their peers than did the French adolescents. Instead, they showed more self-touching and more aggressive verbal and physical behavior.     

Anxiety symptoms in Japanese and in German children

The purpose of this study was to compare the frequency of anxiety symptoms and their association with gender and age in Japanese and German children using the Spence Children's Anxiety Scale (SCAS). A total of 1837 children (862 from Germany and 975 from Japan) between the age of 8 and 12 years were investigated. Results revealed that German children reported significantly higher symptoms of separation anxiety, social phobia, obsessive compulsive disorder, and generalized anxiety disorder than Japanese children. Conversely, Japanese children reported significantly higher scores on symptoms related to physical injury fear. In both countries, girls scored higher than boys on all the scales of the SCAS. Symptoms of separation anxiety and panic decreased with age, whereas social phobia increased with age. The findings underscore the impact of culture on children's anxiety.     

Comparing the effects of differential reinforcement of other behavior and response-cost contingencies on tics in youth with tourette syndrome

Tics are rapid, repetitive, stereotyped movements or vocalizations that arise from neurobiological dysfunction and are influenced by environmental factors. Although persons with tic disorders often experience aversive social reactions in response to tics, little is known about the behavioral effects of such consequences. Along several dimensions, the present study compared the effects of two treatments on tics: response cost (RC) and differential reinforcement of other behavior (DRO). Four children with Tourette syndrome were exposed to free-to-tic baseline, DRO, RC, and quasibaseline rebound evaluation conditions using an alternating treatments design. Both DRO and RC produced substantial decreases in tics from baseline levels. No differential effects of DRO and RC contingencies were seen on self-reported stress or in the strength of the reflexive motivating operation (i.e., premonitory urge) believed to trigger tics, and neither condition produced tic-rebound effects. Implications of these findings and directions for future research are discussed.     

A school-based intervention to reduce aggressive behavior in maladjusted adolescents

A structured group intervention, using bibliotherapy and clarifying processes, was designed to reduce (a) aggressive behavior, (b) endorsement of beliefs that support aggression, and (c) generally maladjusted behavior. Based on the belief that learning is not only a rational process, but incorporates a strong emotionally driven experiential system, this treatment program sets out to deal with emotions associated with aggression. It is psychodynamically oriented, and, like most school treatments implements cognitive and behavioral elements. For 2 years, 117 socially maladjusted male adolescents in three special education schools in Israel participated in the program. Results for the 2 years are inconsistent: the 2nd-year study was more effective than the 1st-year study in reducing aggression as well as other maladjusted social behavior; withdrawal was the only variable affected consistently, and the program did not reduce attitudes that support aggression. The control group, however, showed increased endorsement of beliefs that support aggression and increased aggression and acting-out behavior. These results support the intervention in two ways: (a) They suggest some control over the increase in maladjusted behavior with time, and (b) they indicate a reduction in aggressive behavior for most students. The salient result concerning change in withdrawal behavior is discussed in light of the psychodynamic principles and methods associated with the intervention.     

Smoking and moods in adolescents with depressive and aggressive dispositions: evidence from surveys and electronic diaries.

Surveys and electronic diaries were used to examine depressive and extemalizing dispositions as they relate to smoking and moods in 170 early adolescents. Negative moods were prevalent, with anger and anxiety reported on 26%-60% and sadness on 16%-40% of occasions. The risk of smoking, urges to smoke, and alcohol intake were elevated in teens with aggressive and depressive dispositions, as were diary reports of feeling hassled, angry, and sad. Girls high in depression and aggression also reported more anxiety, stress, and fatigue and less happiness and well-being than did their peers. For boys, depression seemed to dampen the elevated smoking risks associated with externalizing behaviors. Discussion focuses on gender differences in personality-smoking linkages, adolescent negative affectivity, the unique contributions of survey and diary methods, and the promise of targeted preventive interventions such as affect regulation training.     

Cognitions and depressive symptoms among ethnic minority adolescents

Cognitive models have guided effective intervention strategies in the treatment of depression. However, little is known about the cognitive model's relevance in different cultural ethnic groups in the United States. This study examines the cross-sectional and longitudinal associations among cognitive variables and depressive symptoms among African American, Caucasian, and Hispanic adolescents in the United States. Community adolescents (N = 450) ages 14-18 years (African American n = 79; Caucasian n = 273; Hispanic n = 98) provided information regarding their depressive symptoms and cognitions at two surveys, 6 months apart. Self-efficacy, cognitive errors, and hopelessness were associated with concurrent depressive symptoms at baseline. In addition, cognitive errors at baseline, controlling for baseline depressive symptoms and the occurrence of stressful events, predicted depressive symptoms at follow-up. Ethnic differences disappeared when parent education level was controlled. Our findings demonstrate support for the cognitive model of depression across ethnic groups. The importance of controlling for social class when examining ethnic differences in psychological variables is highlighted by our findings.     

The borderline syndrome in adolescents

The borderline adolescent is discussed in terms of diagnostic perspectives, characteristic features based on disturbed object relations, and treatment. The disorder is not fully manifest in adolescence but gradually emerges into a definable personality type, the various features of which express the unsatisfactory outcome of a complex psychodynamic struggle related to developmental arrests in psychic structure. Based on clinical observations, the diagnosis of borderline personality, like the schizoid personality, is considered to be compatible with a past, present or future schizophrenic disorder. Finally, therapeutic approaches in a day-treatment program, and individual therapy is considered from a developmental object relations viewpoint.     

Self-report and stability of physical symptoms by adolescents

Verbal reports of physical complaints and their relationship to school-related stress was investigated in two adolescent samples. It was hypothesized that symptom reporting is a function of age and sex, and is connected to psychological factors such as test (state) and trait anxiety. In addition, the consistency of symptoms reported during the course of one year was evaluated. It was found that, overall, the two adolescent groups complained of more physical symptoms than did Br?hler's (1978) adult sample. Differences between males and females in reporting symptoms were apparent only in the older adolescent group (ages 14 to 15); females reported more physical complaints. The positive correlation between body symptoms and test-trait anxiety was highly significant. During the year, few adolescents exhibited well-defined patterns of body complaints. On the contrary, many complaints seemed to be transient phenomena, although the number was high. In this respect, adolescence plays an important role in the self-reporting evaluation and development of physical complaints.     

A cross-cultural investigation of cognitions and depressive symptoms in adolescents

Adolescents (N=2,272) from Hong Kong and the United States provided information regarding their depressive symptoms, cognitions (self-efficacy, negative cognitive errors, and hopelessness), and stressful events between 2 surveys 6 months apart. Depressive symptoms and hopelessness were higher, and self-efficacy and negative cognitive errors were lower in Hong Kong than in the United States. Cognitions were associated with concurrent depressive symptoms and predicted depressive symptoms 6 months later in both cultures. The "reverse" model was also supported with more variance predicted by depressive symptoms to later cognitions than from cognitions to depressive symptoms. There was some support for the hypothesis that self-efficacy is less salient in collective compared with individualistic cultures. These findings extend cognitive theories of depression to a non-Western culture.     

Stress,sense of coherence and emotional symptoms in adolescents

This paper aims to investigate the association between the domains of stress, sense of coherence (SOC) and emotional symptoms (depression and anxiety) in adolescents, as well as the potential moderating role of SOC on the relationship between stress and emotional symptoms. The study is based on a cross-sectional sample of 1183 adolescents aged 13–18 who attend public elementary and secondary schools in Mid-Norway. The results showed that girls scored higher than boys on stress related to peer pressure, home life, school performance, school/leisure conflict and emotional symptoms. Conversely, boys reported higher SOC than girls. Results from multiple hierarchical regression analyses showed that for boys, stress related to school performance was positively associated with symptoms of both depression and anxiety, whereas stress from peer pressure was associated with depressive symptoms. For girls, stress from peer pressure, romantic relationships and school was associated with more depressive symptoms. SOC was strongly and inversely associated with emotional symptoms, especially anxiety in girls. SOC also moderated the association between stress related to peer pressure and depressive symptoms in both genders. The study provides evidence of the association of SOC with stress and emotional symptoms during adolescence.