A double-blind,sham-controlled,trial of home-administered rhythmic 10-Hz median nerve stimulation for the reduction of tics,and suppression of the urge-to-tic,in individuals with Tourette syndrome and chronic tic disorder

Tourette syndrome (TS) and chronic tic disorder (CTD) are neurological disorders of childhood onset characterized by the occurrence of tics; repetitive, purposeless, movements or vocalizations of short duration which can occur many times throughout a day. Currently, effective treatment for tic disorders is an area of considerable unmet clinical need. We aimed to evaluate the efficacy of a home-administered neuromodulation treatment for tics involving the delivery of rhythmic pulse trains of median nerve stimulation (MNS) delivered via a wearable ‘watch-like’ device worn at the wrist. We conducted a UK-wide parallel double-blind sham-controlled trial for the reduction of tics in individuals with tic disorder. The device was programmed to deliver rhythmic (10 Hz) trains of low-intensity (1–19 mA) electrical stimulation to the median nerve for a pre-determined duration each day, and was intended to be used by each participant in their home once each day, 5 days each week, for a period of 4 weeks. Between 18th March 2022 and 26th September 2022, 135 participants (45 per group) were initially allocated, using stratified randomization, to one of the following groups; active stimulation; sham stimulation or to a waitlist (i.e. treatment as usual) control group. Recruited participants were individuals with confirmed or suspected TS/CTD aged 12 years of age or upward with moderate to severe tics. Researchers involved in the collection or processing of measurement outcomes and assessing the outcomes, as well as participants in the active and sham groups and their legal guardians were all blind to the group allocation. The primary outcome measure used to assess the ‘offline’ or treatment effect of stimulation was the Yale Global Tic Severity Scale–Total Tic Severity Score (YGTSS–TTSS) assessed at the conclusion of 4 weeks of stimulation. The primary outcome measure used to assess the ‘online’ effects of stimulation was tic frequency, measured as the number of tics per minute (TPM) observed, based upon blind analysis of daily video recordings obtained while stimulation was delivered. The results demonstrated that after 4-week stimulation, tic severity (YGTSS-TTSS) had reduced by 7.1 points (35 percentile reduction) for the active stimulation group compared to 2.13/2.11 points for the sham stimulation and waitlist control groups. The reduction in YGTSS–TTSS for the active stimulation group was substantially larger, clinically meaningful (effect size = .5) and statistically significant (p = .02) compared to both the sham stimulation and waitlist control groups, which did not differ from one another (effect size = −.03). Furthermore, blind analyses of video recordings demonstrated that tic frequency (tics per minute) reduced substantially (−15.6 TPM) during active stimulation compared to sham stimulation (−7.7 TPM). This difference represents a statistically significant (p < .03) and clinically meaningful reduction in tic frequency (>25 percentile reduction: effect size = .3). These findings indicate that home-administered rhythmic MNS delivered through a wearable wrist-worn device has the potential to be an effective community-based treatment for tic disorders.     

The properties of geophysical fields and their effects on elephants and other animals

Geophysical properties of acoustic, seismic, electric, and magnetic waveforms create opportunities and constraints for animals' communication and sensory monitoring of the environment. The geometric spreading of waves differs; at some frequencies, transmission is most efficient and has minimal noise. The spreading properties of seismic waves favor long-distance propagation for communication and environmental monitoring, and would benefit elephants (Elephas maximus and Loxodonta africana), such as in locating subsurface water. Extending C. E. O'Connell-Rodwell, B. T. Amason, and L. A. Hart (2000), a man jumping at 1.11 km propagated seismic waves at 10-40 Hz. Given the noise of lightning and the Schumann resonances, near field magnetic and electric transmission by animals would be most efficient around 1000 Hz.     

Can't stop believing: inhibitory control and resistance to misleading testimony

Why are some young children consistently willing to believe what they are told even when it conflicts with first‐hand experience? In this study, we investigated the possibility that this deference reflects an inability to inhibit a prepotent response. Over the course of several trials, 2.5‐ to 3.5‐year‐olds (N = 58) heard an adult contradict their report of a simple event they had both witnessed, and children were asked to resolve this discrepancy. Those who repeatedly deferred to the adult's misleading testimony had more difficulty on an inhibitory control task involving spatial conflict than those who responded more skeptically. These results suggest that responding skeptically to testimony that conflicts with first‐hand experience may be challenging for some young children because it requires inhibiting a normally appropriate bias to believe testimony.     

Does Proximity Matter in Promoting Interfaith Dialogue?

This paper explores the role of physical proximity of places of worship in facilitating interfaith dialogue. The research focuses on a religious cluster within the Greater Toronto Area, which emerged due to incremental zoning changes over time. Using key informant interviews as the method and Allport’s contact hypothesis as the guiding theoretical framework, it explores the effects of proximity and contact (interaction or encounters) on intergroup relations. The findings suggest that physical proximity is not a strong factor in facilitating interfaith dialogue initiatives. However, proximity does seem to have an effect in creating a space for interactions and encounters to occur, which can lead to attitudinal shifts concerning the religious “other.”     

The Role of Temperament in Children's Reliance on Others as Sources of Information

By 3 years of age, children generally have a firm understanding of others' reliability, but there is considerable variation among individual children. Little attention has been paid to factors that influence such individual differences. This study addressed this by assessing the relation between reliability understanding and temperament in children approaching their third birthday. We measured children's ability to judge a speaker's trustworthiness and to selectively learn new information from a reliable informant. Observer ratings provided assessments of children's activity, task orientation, and affect/extraversion. Significant associations between selective trust and the temperament dimension of affect/extraversion were found, along with associations between selective trust and gender and language ability. This indicates that the ability to ascertain whether a speaker is a reliable person from whom to learn is related to several individual child characteristics. Copyright © 2014 John Wiley & Sons, Ltd.     

Interpersonal Neurobiology and Couple Relationship Quality: A Longitudinal Model

Interpersonal neurobiology is an interdisciplinary theory that is being used by couple and family therapists. However, more investigation is needed to determine if this theory can accurately explain family relationships over time. In this study, we used the nationally representative National Longitudinal Study of Adolescent to Adult Health (Add Health) dataset to examine key elements of interpersonal neurobiology theory. Using structural equation modeling, we explored how maternal and paternal support and self-acceptance during adolescence are related to emotional stability and adult couple relationship satisfaction 13 years later (N = 7864). Results indicate that self-acceptance and emotional stability are factors that contribute to couple relationship satisfaction. We conclude with clinical implications of this study, including how to use mindfulness practices to promote healthy relationships.     

Perceptions of the Limitations of Confidentiality Among Chinese Mental Health Practitioners,Adolescents and Their Parents

The present study aims to (a) survey Chinese mental health professionals’ attitudes toward therapeutic confidentiality with adolescent patients in specific clinical situations, and (b) compare Chinese adolescents’ and parents’ beliefs about when most mental health professionals would breach confidentiality. A sample of 36 mental health practitioners, 152 parents, and 164 adolescents completed a survey to assess their opinions about when confidentiality should be breached in 18 specific clinical situations (e.g., an adolescent tells his or her therapist that he or she smoked a cigarette, had unprotected sex, or attempted suicide). Nearly half of the parents (46%) and adolescents (41%) and 78% of the therapists in our sample selected “yes” in response to the question of whether the principle of confidentiality applies to adolescents. However, 49% of parents indicated “no,” and 53% of adolescents indicated “not sure.” Compared to adolescents, parents were significantly more likely to believe that therapists would breach confidentiality for the high-breach-likelihood items. For the low-breach-likelihood items, adolescents and parents were significantly more likely than therapists to believe confidentiality should be breached. Results from this study provide data to inform the development, refinement, practical implementation, and communication of guidelines and recommendations specific to adolescents receiving psychotherapy in China.     

The Relationship Between Family Stress and Behavioral Health Among African American Adolescents

African American youth, especially those who live in low-income communities, are at increased risk for experiencing higher juvenile justice involvement, poorer mental health, low school engagement, higher illicit drug use, and STIs, relative to their higher income peers and those from other ethnic backgrounds. However, few studies have examined the relationship between family stressors and these multiple youth concerns. This study examines the relationship between family stress (i.e., having an adult in the home with a history of mental illness, substance use, and incarceration) and youth concerns such as substance use, mental health challenges, low school engagement, juvenile justice involvement, and STI risk behaviors. A total of 638 African American adolescents living in predominantly low-income, urban communities participated in the study by completing self-report measures on the above constructs. Logistic regressions controlling for age, gender, socioeconomic status, and sexual orientation indicated that adolescents who reported higher rates of family stress were significantly more likely to report mental health problems, delinquent behaviors, juvenile justice involvement, drug use, risky sex, and lower school engagement factors. Findings suggest that attending to the developmental concerns of youth also requires addressing the needs of the family unit.     

Numerical Estimation in Children for Both Positive and Negative Numbers

Numerical estimation has been used to study how children mentally represent numbers for many years (e.g., Siegler & Opfer, 2003). However, these studies have always presented children with positive numbers and positive number lines. Children’s mental representation of negative numbers has never been addressed. The present study tested children in the 2nd, 4th, and 6th grades to assess their mental representations of both positive and negative numbers using a standard numerical estimation task. We replicated the shift from a logarithmic to linear representation for positive numbers (0–1,000 scale) in that 2nd graders represented positive numbers logarithmically, but 4th and 6th graders represented the numbers linearly. Furthermore, children’s representation of negative numbers paralleled their representations of positive numbers and showed the same shift from a logarithmic representation at Grade 2 to linear representations at Grades 4 and 6. This is the first study to provide data on children’s representation of negative numbers, and the implications of these findings are discussed.     

Effects of A Parenting-Focused Mindfulness Intervention on Adolescent Substance Use and Psychopathology: A Randomized Controlled Trial

Substance use and psychopathology symptoms increase in adolescence. One key risk factor for these is high parent stress. Mindfulness interventions reduce stress in adults and may be useful to reduce parent stress and prevent substance use (SU) and psychopathology in adolescents. This study tested the feasibility and effects of a mindfulness intervention for parents on adolescent SU and psychopathology symptoms. Ninety-six mothers of 11–17 year olds were randomly assigned to a mindfulness intervention for parents (the Parenting Mindfully [PM] intervention) or a brief parent education [PE] control group. At pre-intervention, post-intervention, 6-month follow-up, and 1-year follow-up, adolescents reported on SU and mothers and adolescents reported on adolescent externalizing and internalizing symptoms. Primary intent to treat analyses found that the PM intervention prevented increases in adolescent SU over time, relative to the PE control group. The PM intervention also prevented increases in mother-reported externalizing symptoms over time relative to the PE control group. However, PM did not have a significant effect on internalizing symptoms. PM had an indirect effect on adolescent-reported externalizing symptoms through greater mother mindfulness levels at post-intervention, suggesting mother mindfulness as a potential intervention mechanism. Notably, while mothers reported high satisfaction with PM, intervention attendance was low (31% of mothers attended zero sessions). Secondary analyses with mothers who attended?>??=?50% of the interventions (n?=?48) found significant PM effects on externalizing symptoms, but not SU. Overall, findings support mindfulness training for parents as a promising intervention and future studies should work to promote accessibility for stressed parents.

Clinical Trials Identifier: NCT02038231; Date of Registration: January 13, 2014