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.     

Adolescent Gender and Age Differences in Responsiveness to Functional Family Therapy

The current study contributes to a sparse literature on moderators of Functional Family Therapy (FFT) by examining whether responsiveness to FFT, measured by a broad range of outcomes, varies by adolescent gender, age, and their interaction. This study was informed by 687 families (n, adolescents = 581; n, caregivers = 933) and utilized a pre–post comparison design. Fixed-effects regressions with gender, age, and their interaction included as explanatory variables were conducted to calculate the average change in youth mental health, callous–unemotional traits, academic outcomes, substance use, and family functioning. Moderation analyses revealed that according to parent report, girls had significantly greater improvements in peer problems and family functioning, and boys benefited more in increased liking of school. There were differential effects by age, such that older youth had less beneficial mental health outcomes and a smaller decrease in frequency of hash use. The gender by age interaction was significant for adolescents’ report of mental health and family functioning outcomes, which suggests that girls benefit from FFT less than boys during early adolescence, but benefit more than boys in late adolescence. This finding adds to literature which has evidenced that family functioning is particularly important for girls by suggesting that FFT is important for improving older girls’ mental health and family functioning in particular. The study’s results expand the examination of outcomes of FFT to include academic outcomes, and provide insight into key factors that should be considered in addressing adolescent behavioral problems and family functioning.     

Self-efficacy and social behavior

Data regarding the relationship between self-efficacy and social behavior are limited, and questions remain about how to interpret the relationship of self-efficacy to phobic behavior in general. The current study includes data regarding the relationship between self-efficacy ratings and social behavior. The data also allow tests of an alternative hypothesis that self-efficacy ratings represent a general prediction regarding the likely outcome regarding a task. If this hypothesis is correct, the relationship of self-efficacy to behavior should be moderated by task familiarity. The study involved 124 socially anxious participants who gave at least partial data on a variety of measures, including three speaking tasks. In accordance with the alternative hypothesis, self-efficacy ratings best predicted behavior in reference to a familiar speaking task. Overall, self-efficacy showed only a moderate tendency to predict behavior.     

The Child Behavior Checklist for Group Care Workers: A Study Regarding the Factor Structure

In this study we examined the factor structure of the Child Behavior Checklist (CBCL) filled out by group care workers. Group care workers' judgements were collected on 846 children and adolescents treated in various residential settings in The Netherlands. Using confirmatory factor analysis, we were able to show that the original CBCL factor model based on parental judgments of child behavior also fits for the judgments of group care workers. This means that the well known 8 narrow-band syndromes (Withdrawn, Somatic Complaints, etc.) as well as the 2 broad-band syndromes (Internalizing and Externalizing) can be used to interpret the CBCL scores of group care workers. This confirmation of the CBCL factor structure is a first step to add a group care worker version to the CBCL family. However, as a second step, normative data need to be gathered to further enhance the use of the CBCL for group care workers.     

Spatial and non-spatial visual discrimination learning in zebrafish (Danio rerio)

Zebrafish (Danio rerio) provide an excellent model for assessment of molecular processes of neurodevelopment. To determine the functional importance of molecular events during neurodevelopment, we have developed methods for assessing learning in zebrafish in a three-chambered fish tank. In the first study, simple escape response was assessed. Zebrafish tested with a moving net learned to escape to another chamber more rapidly over the six sessions of training than the fish with the still net which did not learn. Upon reversal of the contingencies, the fish switched to the inactive net rapidly learned to suppress the escape response and fish formerly in the inactive net condition learned to avoid the moving net. In the second study, spatial discrimination learning was assessed. Zebrafish were trained on a right-left position discrimination to avoid the active net. Zebrafish showed significant improvement in escape responses over six sessions of training with three trials per session. In the third study, red-blue non-spatial discrimination learning was assessed. There was a significant improvement over the first six training sessions. With the reversal of contingencies, there was a significant decline of performance. With continued training, the fish again significantly improved avoidance. These studies found an effective motivational stimulus and procedure for studying escape behavior in zebrafish; a procedure whereby zebrafish would learn both spatial and non-spatial discrimination. These methods are being developed to help determine the functional importance of molecular events during zebrafish neurodevelopment. Accepted after revision: 20 August 2001 Electronic Publication     

On the Induction and Consequences of Variation in Behavior Perception

Research indicates that perceivers regulate information gain from their observation of ongoing behavior by varying the number and kind of actions they identify as meaningful. Although numerous factors have been shown to induce variation in this behavior-perception process, it is not currently known whether observers must consciously and intentionally initiate these changes. To address this question, different observational goals (impression formation or memorization) were nonconsciously primed in participants who then viewed and segmented a behavior sequence into meaningful actions. Although participants were unaware of its effects, the priming manipulation led to quantitative and qualitative shifts in their perception of the behavior that were similar to those found in a previous study in which observational goals were manipulated via explicit instructions. Importantly, these shifts in perception, in turn, influenced evaluations of the observed actor and memory for her behavior. We conclude that an act of will is not required for adjustments in behavior perception to be initiated, and, furthermore, that a full understanding of social judgment cannot be achieved without examination of the behavior-perception process.

Effectiveness of a Parent Training Program for Improving Children’s Social Behavior

We tested the efficacy of a social skills training program for the parents of school-aged children experiencing socio-emotional problems. Participating families (N = 42) were randomly assigned to one of three conditions: parent social skills training; parent plus parallel child social skills training; or no-treatment control. The two treatment groups did not differ on any of the outcome measures. Treatment was associated with improvements in parent and child social skills knowledge, parent social problem solving, and child emotional functioning. In follow-up analyses examining mechanisms of change, parental attendance and change in child social skills knowledge predicted response to treatment. Overall, our results highlight the utility of engaging parents as primary participants in the treatment of children’s socio-emotional problems and suggest methods for maximizing the impact of such an intervention.     

A Pilot Study of a Mental Silence Form of Meditation for Women in Perimenopause

Menopausal symptoms often feature or are worsened by psychological and psychosomatic factors. As there is limited research into the potential role of psychological interventions, especially meditation, for the treatment of these symptoms the current study adopted an AB case series design with a follow-up phase. Fourteen women who were experiencing hot flashes and other menopausal symptoms and receiving no treatment for them attended meditation classes twice weekly for 8 weeks and practiced daily at home. A mental silence orientated technique of meditation called Sahaja Yoga (SYM) was taught. The Hot Flash Diary, Kupperman Index, MENQOL, Greene’s Climacteric Scale and STAI, were administered at baseline, mid treatment (4 weeks), post-treatment (8 weeks) and at 8 weeks follow-up. Substantial improvements in all measures occurred at post treatment. Changes in vasomotor symptoms, especially hot flashes, were most prominent as a significant decrease of 67% at post-treatment and 57% at follow-up (χ² = 11.7, p < .003) were noted and Kupperman’s Index score decreased by 58% at post-treatment and 40% at follow-up (χ² = 11.7, p < .005). All other symptom measures improved substantially from baseline to post-treatment, non-parametric analysis indicating that most of these changes were significant. These findings tentatively suggest that menopausal symptoms, especially vasomotor symptoms, and particularly hot flashes, might be substantially improved by using meditation.     

Early Student-Teacher Relationships of Children With and Without Intellectual Disability: Contributions of Behavioral, Social, and Self-Regulatory Competence

We investigated the student-teacher relationships (STRs) of 6-year-old children with (n = 58) and without (n = 82) intellectual disability (ID). We also examined early (age 3) and concurrent (age 6) child behavioral, self-regulatory, and social characteristics as predictors of age 6 STR quality. Children with ID experienced significantly poorer relationships with their teachers, marked by less closeness and more conflict and dependency, compared to typically developing children. This group difference was not accounted for entirely by IQ differences. Child characteristics and parent-child interactional variables at age 3 and 6 accounted for 53.5% of the variance in age 6 STR quality. The relation between ID status and STR quality was fully mediated by three child variables-global self-regulation at age 3, mother-reported behavior problems at age 6, and teacher-reported behavior problems at age 6- and was partially mediated by mother-reported behavior problems at age 3. Our findings demonstrate the importance of child behavioral and social characteristics in predicting relationships with teachers for children with and without ID.     

Proactive, early screening to detect behaviorally at-risk students: Issues, approaches, emerging innovations, and professional practices

This article provides a review of current practices and tools used in the proactive screening of behaviorally at-risk students within the context of schooling. While there are many obstacles to the early detection of vulnerable students, some recent developments have helped make educators more receptive to early identification and prevention approaches. In addition to describing current best practices, this article reviews promising innovations in screening and early identification that the authors believe are worth considering and whose structural characteristics, required accommodations, and critical features may make them more acceptable to educational users. Implications for the training of school psychologists in the screening and early identification of high-risk students are reviewed and recommendations offered for future research.