Development and Open Trial of a Psychosocial Intervention for Young Children With Chronic Tics: The CBIT-JR Study

The Comprehensive Behavioral Intervention for Tic Disorders (CBIT) has demonstrated efficacy in large randomized controlled trials for children (≥9 yrs), adolescents and adults with Tourette Syndrome and Chronic Tic Disorders. Given the early age of onset for tic disorders, a large portion of affected individuals with chronic tic disorders are less than 9 years of age and appropriate developmental adaptations of behavioral treatment have not yet been tested. The goal of this study was to adapt and evaluate the acceptability and utility of a family-based adaptation of CBIT for children under 9 years of age. Children 5–8 years of age (N = 15) with chronic tics were recruited from three study sites. CBIT was adapted for use with young children and included habit reversal strategies introduced in a developmentally appropriate game format and function-based interventions to reduce family accommodation of and attention to tic symptoms.Children and parents described high level of treatment satisfaction and study retention rate was 100%. Treatment response rate was 54% (CGI-I = 1 or 2) with a significant decrease in the YGTSS total score (Cohen’s d = 0.73) that was largely maintained at 3-month and 1-year follow-up assessments. Treatment was associated with reduction of some symptoms of tic-related comorbid syndromes and with changes in parental accommodation and attention to tics.Future research should determine if parental attention to tics and symptom accommodation are important mediators of treatment outcome, or if participating in this intervention at a younger age may prevent the chronic course of tic symptoms.     

Global dot integration in typically developing children and in Williams Syndrome

Williams Syndrome (WS) is a neurodevelopmental disorder that results in deficits in visuospatial perception and cognition. The dorsal stream vulnerability hypothesis in WS predicts that visual motion processes are more susceptible to damage than visual form processes. We asked WS participants and typically developing children to detect the global structure Glass patterns, under “static” and “dynamic” conditions in order to evaluate this hypothesis. Sequentially presented Glass patterns are coined as dynamic because they induce illusory motion, which is modeled after the interaction between orientation (form) and direction (motion) mechanisms. If the dorsal stream vulnerability holds in WS participants, then they should process real and illusory motion atypically. However, results are consistent with the idea that form and motion integration mechanisms are functionally delayed or attenuated in WS. Form coherence thresholds for both static and dynamic Glass patterns in WS were similar to those of 4–5 year old children, younger than what is predicted by mental age. Dynamic presentation of Glass patterns improved thresholds to the same degree as typical participants. Motion coherence thresholds in WS were similar to those of mental age matches. These data pose constraints on the dorsal vulnerability hypothesis, and refine our understanding of the relationship between form and motion processing in development.     

Transference in the residential treatment of children

Abbreviated version of a lecture delivered before the Medical Section of the British Psychological Society in London on May 24th, 1977.     

Functional Analysis Identified Habit Reversal Components for the Treatment of Motor Tics

This study included brief functional analyses and treatment for motor tics exhibited by two children with Tourette Syndrome. Brief functional analyses were conducted in an outpatient treatment center and results were used to develop individualized habit reversal procedures. Treatment data were collected in clinic for one child and in clinic and school for the other child. Brief functional analysis results were mixed for each child, but provided useful information for informing unique habit reversal components for each child. Treatment results indicated reductions in motor tics for each child. Results are discussed in terms of utility of functional analysis for tics.     

Atypical Neuropsychological Profile in a Boy with 22q11.2 Deletion Syndrome Keywords:

In this article the general and specific cognitive impairments of the boy R.H. with a de novo deletion 22q11.2 are described. His full-scale IQ was 73, and he obtained only slightly better verbal than non-verbal subtest scores. Neuropsychological assessment revealed specific impairments in perceptual categorization of objects presented suboptimal, matching of unfamiliar faces, and verbal learning and memory. In contrast, he performed in accordance with his intelligence level on other visual perceptual tasks, on non-verbal learning and memory tasks, and on attention tasks. Voxel-wise statistical comparison of a high-resolution T1-weighted magnetic resonance image of R.H’s brain with similar images obtained from 14 normal control children revealed as major abnormalities a reduction of the right inferior parietal and superior occipital lobe, and a bilateral reduction of deep white matter behind the inferior frontal gyrus. These cognitive impairments and MRI abnormalities are not commonly described in 22q11.2 Deletion Syndrome and may indicate a larger heterogeneity in the neurocognitive phenotype than currently evidenced. At least in this boy the microdeletion seems to have interfered with the development and functioning of particular neural subsystems, while the structure and functioning of other subsystems was left intact.     

Working with children with Asperger's Syndrome in the mainstream classroom: A psychodynamic take from the chalk face

There has been considerable discussion by those involved in teaching children with special educational needs (SENs) about how to appropriately categorize children with difficulties in learning. Increasingly, a social inclusion model of SEN has come to the fore in mainstream schools across the developed world. Asperger's Syndrome (AS), however, has presented a challenge to inclusionary approaches. This paper, based on the experiences of a teacher working with a child with AS in the mainstream classroom, explores the role of emotions in relation to the obsessional interests of children with AS. Particular reference is paid to the work of later object relations theorists on the emotional role of rigid patterns of thinking, behaviour and obsessional interest in AS. The possibility that an implicit deficit model may at times be relevant to the development of ‘live’ communication and learning for children with AS in the mainstream classroom is considered. Possible management strategies in the classroom in relation to obsessive interests are discussed.     

Extended cognition and the space of social interaction

The extended mind thesis (EM) asserts that some cognitive processes are (partially) composed of actions consisting of the manipulation and exploitation of environmental structures. Might some processes at the root of social cognition have a similarly extended structure? In this paper, I argue that social cognition is fundamentally an interactive form of space management—the negotiation and management of “we-space”—and that some of the expressive actions involved in the negotiation and management of we-space (gesture, touch, facial and whole-body expressions) drive basic processes of interpersonal understanding and thus do genuine social-cognitive work. Social interaction is a kind of extended social cognition, driven and at least partially constituted by environmental (non-neural) scaffolding. Challenging the Theory of Mind paradigm, I draw upon research from gesture studies, developmental psychology, and work on Moebius Syndrome to support this thesis.     

Social skills in women with Turner Syndrome

The aim of this study was to evaluate the performance of a group of women with Turner Syndrome (TS) in interpersonal situations where several social skills were required, and to compare the results with unaffected sisters. Fifty-two TS females aged 15-35 years and 33 sisters aged 16-43 were evaluated using Del-Prette Social Skills Inventory (SSI) and individual interviews. Thirty mothers to subjects and sisters answered questionnaires. It was found that TS girls' performance in SSI was as good as their sisters' and even better in meeting new people and facing unknown situations (p = 0.020). Older TS women scored better than younger ones, differently from their sisters. There were no significant correlations between total score of TS women and their age at diagnosis, time of follow-up and height z-score. Mothers reported having more problems with TS girls than with sisters. Although TS girls demonstrated having social difficulties, just a few of them spontaneously complained about interpersonal problems in the interview. Results suggest that social difficulties may not cause TS girls major problems nor make them unhappy with their social lives, and/or TS girls may not be able to perceive their own difficulties. Good performance in SSI also suggests that TS girls can identify adequate skills in presented situations and answer in a way to obtain good scores, but they may not necessarily use their skills due to other factors like anxiety and shyness. They may also have a tendency to answer SSI in a way they consider socially desirable, masking their real difficulties.     

Measuring Shaken Baby Syndrome awareness: preliminary reliability of a caregiver attitudes and beliefs survey

Recent estimates of Shaken Baby Syndrome awareness suggest that approximately half of all American adults have not heard of the often devastating risks of shaking an infant. Using a sample of 288 undergraduate students, we developed a measure of attitudes around infant care practices. A total of 264 community participants completed a revised survey. Between-group comparisons, exploratory factor analyses, and internal consistency tests were employed to determine the directionality and reliability of any scale structure present in the data. A five factor structure fits the data reliably, and each of these factors seems to represent a unique dimension. Implications for using this measure clinically and preventatively are discussed.