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.     

Estimating rates of chronic fatigue syndrome from a community-based sample: A pilot study

Most of the Chronic Fatigue Syndrome (CFS) epidemiological studies have relied on physicians who refer patients having at least 6 months of chronic fatigue and other symptoms. However, there are a number of potential problems when using this method to derive prevalence statistics. For example, some individuals with CFS might not have the economic resources to access medical care. Other individuals with CFS might be reluctant to use medical personnel, particularly if they have encountered physicians skeptical of the authenticity of their illness. In addition, physicians that are skeptical of the existence of CFS might not identify cases. In the present pilot study, a random community sample (N=1,031) was interviewed by telephone in order to identify and comprehensively evaluate individuals with symptoms of CFS and those who self-report having CFS. Different definitions of CFS were employed, and higher rates (0.2%) of CFS were found than in previous studies. Methodological benefits in using more rigorous epidemiological methods when estimating CFS prevalence rates are discussed. The authors appreciate the generous financial support of the CFIDS Association and Minnan, Inc. We also are grateful for many helpful suggestions provided by Judith A. Richman, William McCready, Wendell Richmond, and Stephen E. Goldston. Finally, we are very thankful to the many undergraduate volunteers who helped us complete this study, and they include Cheryl Stenzel, Georgina DeLa Torre, Vickie Chrisos, Don Banik, Hillary Loeb, Leslie Ramesack, Ellen Diamond, Rob Bleeker, Gib Garza III, Mindy Silverstein, Kadip Sen, Meredith Lombrazo, Brian Miller, Caroline Marsden, Lorraine Whitmore, Stan Gayot, Karen Costakis, and Dave Sobotka.     

Integration and authority: rescuing the ‘one thought too many’ problem

Four decades ago, Bernard Williams accused Kantian moral theory of providing agents with ‘one thought too many’. The general consensus among contemporary Kantians is that this objection has been decisively answered. In this paper, I reconstruct the problem, showing that Williams was not principally concerned with how agents are to think in emergency situations, but rather with how moral theories are to be integrated into recognizably human lives. I show that various Kantian responses to Williams provide inadequate materials for solving this ‘integration problem’, and that they are correspondingly ill-positioned to account for the authority of morality, as Williams suspected all along.     

Parents of children with Down Syndrome: Do resilience and social support matter to their experience of carer stress?

The study investigated personal resilience influences on the relationship between social support and parenting-stress among parents of children with Down syndrome (DS) in a Nigerian sample. One hundred and ninety three parent-carers of children with DS participated in the study (mothers?=?59%; mean age?=?46.47, age range?=?21 to 67, SD?=?10.42). The parent-carers responded to the measures of parenting-stress, perceived social support, and resilience. The result of the moderated multiple linear regression showed that parents with high social support and resilience have lower level of parenting-stress. Higher personal resilience significantly moderated the relationship between social support and parenting-stress so that parent-carers with low level of social support and higher personal resilience had lower level of parenting-stress. Resilience and social support oriented therapy appears to have efficacy for helping parent-carers of children with DS to manage their stress arising from raising such children.     

The ‘Constitutive Thought’ of Regret

In this paper I defend and develop Bernard Williams’ claim that the ‘constitutive thought’ of regret is ‘something like “how much better if it had been otherwise”’. An introductory section on cognitivist theories of emotion is followed by a detailed investigation of the concept of ‘agent-regret’ and of the ways in which the ‘constitutive thought’ might be articulated in different situations in which agents acknowledge casual responsibility for bringing about undesirable outcomes. Among problematic cases discussed are those in which agents have caused harm through no fault of their own, or have been constrained to choose the lesser of two evils or to act against their moral values. R. Jay Wallace’s ‘bourgeois predicament’ and related cases, in which we recognize that our present advantages have flowed from regrettable antecedents, further show that regret is often not a simple emotion, and it is argued that conflicted regrets are sometimes unavoidable. Finally, the paper looks at Descartes’ account of regret as a form of sadness engendered by the recollection of irrecoverable happy experiences, to which the ‘constitutive thought’ does not readily apply. It is suggested that what Descartes is discussing is a different genre of emotion for which ‘nostalgia’ might be a better name.     

The sacramental nature of peacemaking rituals: a case for a sacramental spirituality of reconciliation

South African scholar and peace activist John de Gruchy sees a close relationship between sacraments and peacemaking processes. Even though a Protestant, he calls the Church a sacramental community and the Truth and Reconciliation Commission (TRC) a ‘civic sacrament’. This raises the question of the relationship between processes and rituals of peacemaking and sacramentality. Moreover, how does reconciliation, as a core doctrine of Christian theology, relate to sacramentality and peacemaking efforts in society? Is reconciliation sacramental? Hans Boersma’s sacramental ontology provides a theological basis for an affirmative answer. Furthermore, the notion of Christ (and the Church) as primal sacrament(s) (Semmelroth, Schillebeeckx) gives a further basis to see processes of peacemaking as sacramental. The article argues for a sacramental spirituality of reconciliation (Schreiter). However, applying the arguments to two concrete cases, the TRC and the twinning of Coventry and Dresden, shows some difficulties in claiming sacramental status for reconciliation efforts.     

Vulvar pain: a phenomenological study of couples in search of effective diagnosis and treatment

Vulvar vestibulitis syndrome (VVS), a vulvar pain disorder, continues to puzzle medical and mental health professionals due to its unknown etiology and lack of effective treatment. This study used transcendental phenomenology methodology to explore the experiences of couples in which the woman has a diagnosis of VVS. Sixteen in-depth semi-structured interviews were conducted with 13 heterosexual couples and 3 women. Four essences emerged: (1) In search of ... the medical journey required extensive searching for knowledgeable and respectful practitioners to provide treatment. (2) The process of developing a personal understanding of this disorder led many couples to question their role in causing and maintaining VVS. (3) Developing strategies for coping with painful intercourse led to three strategies: becoming non-sexual, using alternatives to vaginal sex, and altering or enduring painful intercourse. (4) Feelings of isolation were experienced as adapting to this chronic pain syndrome was often a lonely process. Clinical suggestions included: treating the couple, not just the woman with VVS; encouraging couples to broaden definitions about the importance and primacy of vaginal intercourse and suggest alternative sexual activities less likely to cause vulvar pain; developing shared meaning as a couple, and assisting couples in locating physicians and resources. Suggestions are relevant for couples with VVS and those with chronic health problems affecting sexual relationships.     

Family Impact of Tourette's Syndrome

Tourette's syndrome (TS) is a neuropsychological disorder characterized by vocal and motor tics. TS is also associated with several behavior disorders such as Attention Deficit Hyperactivity Disorder, Oppositional Defiant Disorder, conduct disorder, and Obsessive-Compulsive Disorder. We examined the impact of Tourette's syndrome with and without comorbid psychiatric disorders on the family. TS complicated by comorbid disorders had a greater impact on the family than uncomplicated TS. Tourette's symptom severity was significantly correlated with the level of impact on the family and with the number of comorbid disorders. TS is a disorder with effects that extend beyond motor and vocal tics.     

Delineation of a spatial working memory profile using a non-verbal eye-tracking paradigm in young children with autism and Williams syndrome

Working memory deficits profoundly inhibit children’s ability to learn. While deficits have been identified in disorders such as autism spectrum disorder (ASD) and Williams syndrome (WS), findings are equivocal, and very little is known about the nature of these deficits early in development. A major barrier to advances in this area is the availability of tasks suitable for young children with neurodevelopmental disorders who experience difficulties with following verbal instructions or who are distressed by formal testing demands. To address these issues, a novel eye-tracking paradigm was designed based on an adaptation of the classic A not B paradigm in order to examine the early foundations of spatial working memory capabilities in 26 developmentally delayed preschool children with ASD, 18 age- and IQ-matched children with WS, and 19 age-matched typically-developing (TD) children. The results revealed evidence that foundational spatial working memory performance in ASD and WS was comparable with that of TD children. Performance was associated with intellectual ability in the ASD and TD groups, but not in the WS group. Performance was not associated with adaptive behavior in any group. These findings are discussed in the context of previous research that has been largely limited to older and substantially less developmentally delayed children with these neurodevelopmental disorders.