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European Child & Adolescent Psychiatry

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01-07-2007 | ORIGINAL CONTRIBUTION

Executive functions in children with chronic tic disorders with/without ADHD: new insights

Authors: Dr. Veit Roessner, Andreas Becker, Tobias Banaschewski, Aribert Rothenberger

Published in: European Child & Adolescent Psychiatry | Special Issue 1/2007

Abstract

Objective

In Chronic Tic Disorders (CTD) associated Attention Deficit Hyperactivity Disorder (ADHD) is very common. Hence, it is important to clarify how both conditions are related to cognitive dysfunctions in patients with CTD+ADHD comorbidity. Recent studies on neuropsychology revealed equivocal results, mostly due to methodological shortcomings like problems in sample composition. Thus better and more detailed information on this topic is needed to improve diagnostic and treatment approaches.

Method

Three tasks related to different domains of executive functions (the Matching Familiar Figures Test, the Stroop color–word interference task, and a computerized version of the Wisconsin Card Sorting Test) have been performed in two independent samples (altogether n = 138 children) both including four groups of children (CTD-only, CTD+ADHD, ADHD-only, healthy controls) matched for age and IQ. To specify the influence of either tics or ADHD-symptoms on executive functions and to answer the question of their interactive or additive relationship two-way analyses of variance (MANOVA) for the factors CTD (yes,no) × ADHD (yes,no) were conducted. Eta squared was calculated to reveal the effect sizes for each factor. For a deeper understanding of group differences and to better enable the comparison with data in literature, additional analyses of variance (ANOVA) with posthoc testing were applied.

Results

In summary, there was a main effect only for the factor ADHD reflected by decreased performance, while no main effect of the factor CTD could be found. Admittedly, the effects were not uniform in both samples. However, in all three tasks and both samples, uniformly no interaction between the main factors has been observed.

Conclusions

In cases of coexisting CTD+ADHD the factor ADHD shows the main negative impact on neuropsychological performance and this impact seems to be independent of any feature of the coexisting tics (additive model). This supports the notion to primarily treat the ADHD-symptoms in order to increase cognitive self regulatory abilities of these children. Contrarily, tics seem to have little impact on cognitive performance in most cases.

Achenbach TM (1991) Manual for the child behavior checklist/4–18 and 1991 profile. University of Vermont, Department of Psychiatry, Burlington, VT

American-Psychiatric-Association (1987) Diagnostic and statistical manual of mental disorders. American Psychiatric Association, Washington

American-Psychiatric-Association (1994) Diagnostic and statistical manual of mental disorders. American Psychiatric Association, Washington

Avila C, Cuenca I, Felix V, Parcet MA, Miranda A (2004) Measuring impulsivity in school-aged boys and examining its relationship with ADHD and ODD ratings. J Abnorm Child Psychol 32:295–304PubMedCrossRef

Banaschewski T, Coghill D, Santosh P, Zuddas A, Asherson P, Buitelaar J, Danckaerts M, Dopfner M, Faraone SV, Rothenberger A, Sergeant J, Steinhausen HC, Sonuga-Barke EJ, Taylor E (2006) Long-acting medications for the hyperkinetic disorders: A systematic review and European treatment guideline. Eur Child Adolesc Psychiatry 15:476–495PubMedCrossRef

Bäumler G (1985) Farbe-Wort-Interferenztest nach J.R. Stroop (FWIT). Hogrefe, Göttingen

Berg CZ, Whitaker A, Davies M, Flament MF, Rapoport JL (1988) The survey form of the Leyton Obsessional Inventory-Child Version: norms from an epidemiological study. J Am Acad Child Adolesc Psychiatry 27:759–763PubMedCrossRef

Bornstein RA (1991) Neuropsychological correlates of obsessive characteristics in Tourette syndrome. J Neuropsychiatry Clin Neurosci 3:157–162PubMed

Bornstein RA, Yang V (1991) Neuropsychological performance in medicated and unmedicated patients with Tourette’s disorder. Am J Psychiatry 148:468–471PubMed

10.

Brand N, Geenen R, Oudenhoven M, Lindenborn B, van der Ree A, Cohen-Kettenis P, Buitelaar JK (2002) Brief report: cognitive functioning in children with Tourette’s syndrome with and without comorbid ADHD. J Pediatr Psychol 27:203–208PubMedCrossRef

11.

Brown L, Dure LS (2005) The treatment of comorbid attention-deficit disorder and Tourette’s syndrome. In: Kurlan R (ed) Handbook of Tourette’s syndrome and related tic and behavioral disorders. Marcel Dekker, New York, pp 455–465

12.

Cardona F, Romano A, Bollea L, Chiarotti F (2004) Psychopathological problems in children affected by tic disorders - study on a large Italian population. Eur Child Adolesc Psychiatry 13:166–171PubMedCrossRef

13.

Carter AS, O’Donnell DA, Schultz RT, Scahill L, Leckman JF, Pauls DL (2000) Social and emotional adjustment in children affected with Gilles de la Tourette’s syndrome: associations with ADHD and family functioning. Attention Deficit Hyperactivity Disorder. J Child Psychol Psychiatry 41:215–223PubMedCrossRef

14.

Channon S, Crawford S, Vakili K, Robertson MM (2003) Real-life-type problem solving in Tourette syndrome. Cogn Behav Neurol 16:3–15PubMedCrossRef

15.

Channon S, Flynn D, Robertson MM (1992) Attentional deficits in Gilles de la Tourette syndrome. Neuropsychiat Neuropsychol Behav Neurol 5:170–177

16.

Channon S, Pratt P, Robertson MM (2003) Executive function, memory, and learning in Tourette’s syndrome. Neuropsychology 17:247–254PubMedCrossRef

17.

Channon S, Sinclair E, Waller D, Healey L, Robertson MM (2004) Social cognition in Tourette’s syndrome: intact theory of mind and impaired inhibitory functioning. J Autism Dev Disord 34:669–677PubMedCrossRef

18.

Cirino PT, Chapieski LM, Massman PJ (2000) Card sorting performance and ADHD symptomatology in children and adolescents with tourette syndrome. J Clin Exp Neuropsychol 22:245–256PubMed

19.

Coffey BJ, Park KS (1997) Behavioral and emotional aspects of Tourette syndrome. Neurol Clin 15:277–289PubMedCrossRef

20.

Como PG (2005) Neuropsychological function in Tourette’s Syndrome. In: Kurlan R (ed) Handbook of Tourette’s syndrome and related tic and behavioral disorders. Marcel Dekker, New York, p 237–252

21.

Dilling H, Mombour W, Schmidt MH (2000) Internationale Klassifikation psychischer Störungen, ICD-10, Kapitel V (F). Huber, Bern

22.

Eapen V, Laker M, Anfield A, Dobbs J, Robertson MM (2001) Prevalence of tics and Tourette syndrome in an inpatient adult psychiatry setting. J Psychiatry Neurosci 26:417–420PubMed

23.

Freeman RD, Fast DK, Burd L, Kerbeshian J, Robertson MM, Sandor P (2000) An international perspective on Tourette syndrome: selected findings from 3,500 individuals in 22 countries. Dev Med Child Neurol 42:436–447PubMedCrossRef

24.

Georgiou N, Bradshaw JL, Phillips JG, Bradshaw JA, Chiu E (1995) Advance information and movement sequencing in Gilles de la Tourette’s syndrome. J Neurol Neurosurg Psychiatry 58:184–191PubMed

25.

Goyette CH, Conners CK, Ulrich RF (1978) Normative data on revised Conners Parent and Teacher Rating Scales. J Abnorm Child Psychol 6:221–236PubMedCrossRef

26.

Harris EL, Schuerholz LJ, Singer HS, Reader MJ, Brown JE, Cox C, Mohr J, Chase GA, Denckla MB (1995) Executive function in children with Tourette syndrome and/or attention deficit hyperactivity disorder. J Int Neuropsychol Soc 1:511–516PubMed

27.

Himle MB, Woods DW (2005) An experimental evaluation of tic suppression and the tic rebound effect. Behav Res Ther 43:1443–1451PubMedCrossRef

28.

Kagan J (1966) Reflection–impulsivity: the generality and dynamics of conceptual tempo. J Abnorm Psychol 71:17–24PubMedCrossRef

29.

Kirov R, Kinkelbur J, Banaschewski T, Rothenberger A (2007) Sleep patterns in children with attention-deficit/hyperactivity disorder, tic disorder and comorbidity. J Child Psychol Psychiatry 48:561–570PubMedCrossRef

30.

Kuelz AK, Hohagen F, Voderholzer U (2004) Neuropsychological performance in obsessive-compulsive disorder: a critical review. Biol Psychol 65:185–236PubMedCrossRef

31.

Kurlan R, Como PG, Miller B, Palumbo D, Deeley C, Andresen EM, Eapen S, McDermott MP (2002) The behavioral spectrum of tic disorders: a community-based study. Neurology 59:414–420PubMed

32.

Leon-Carrion J, Garcia-Orza J, Perez-Santamaria FJ (2004) Development of the inhibitory component of the executive functions in children and adolescents. Int J Neurosci 114:1291–1311PubMedCrossRef

33.

Mahone EM, Cirino PT, Cutting LE, Cerrone PM, Hagelthorn KM, Hiemenz JR, Singer HS, Denckla MB (2002) Validity of the behavior rating inventory of executive function in children with ADHD and/or Tourette syndrome. Arch Clin Neuropsychol 17:643–662PubMedCrossRef

34.

Milner B (1963) Effects of different brain lesions on card sorting. Arch Neurol 9:100–110

35.

Moll GH, Heinrich H, Trott GE, Wirth S, Bock N, Rothenberger A (2001) Children with comorbid attention-deficit-hyperactivity disorder and tic disorder: evidence for additive inhibitory deficits within the motor system. Ann Neurol 49:393–396PubMedCrossRef

36.

Mostofsky SH, Lasker AG, Singer HS, Denckla MB, Zee DS (2001) Oculomotor abnormalities in boys with tourette syndrome with and without ADHD. J Am Acad Child Adolesc Psychiatry 40:1464–1472PubMedCrossRef

37.

Nigg JT (2005) Neuropsychologic theory and findings in attention-deficit/hyperactivity disorder: the state of the field and salient challenges for the coming decade. Biol Psychiatry 57:1424–1435PubMedCrossRef

38.

Osmon DC, Smerz JM (2005) Neuropsychological evaluation in the diagnosis and treatment of Tourette’s syndrome. Behav Modif 29:746–783PubMedCrossRef

39.

Ozonoff S, Jensen J (1999) Brief report: specific executive function profiles in three neurodevelopmental disorders. J Autism Dev Disord 29:171–177PubMedCrossRef

40.

Ozonoff S, Strayer DL, McMahon WM, Filloux F (1998) Inhibitory deficits in Tourette syndrome: a function of comorbidity and symptom severity. J Child Psychol Psychiatry 39:1109–1118PubMedCrossRef

41.

Pennington BF, Ozonoff S (1996) Executive functions and developmental psychopathology. J Child Psychol Psychiatry 37:51–87PubMedCrossRef

42.

Peterson BS, Cohen DJ (1998) The treatment of Tourette’s syndrome: multimodal, developmental intervention. J Clin Psychiatry 59(Suppl 1):62–72 (discussion 73–64)PubMed

43.

Peterson BS, Pine DS, Cohen P, Brook JS (2001) Prospective, longitudinal study of tic, obsessive-compulsive, and attention-deficit/hyperactivity disorders in an epidemiological sample. J Am Acad Child Adolesc Psychiatry 40:685–695PubMedCrossRef

44.

Randolph C, Hyde TM, Gold JM, Goldberg TE, Weinberger DR (1993) Tourette’s syndrome in monozygotic twins. Relationship of tic severity to neuropsychological function. Arch Neurol 50:725–728PubMed

45.

Robertson MM (2006) Attention deficit hyperactivity disorder, tics and Tourette’s syndrome: the relationship and treatment implications. A commentary. Eur Child Adolesc Psychiatry 15:1–11PubMedCrossRef

46.

Robertson MM (2000) Tourette syndrome, associated conditions and the complexities of treatment. Brain 123 Pt 3:425–462

47.

Roessner V, Becker A, Banaschewski T, Rothenberger A (2007) Developmental psychopathology in chronic tic disorders with and without ADHD. Eur Child Adolesc Psychiatry Supplement 1

48.

Roessner V, Becker A, Banaschewski T, Rothenberger A (2007) Psychopathological profile in children with chronic tic disorder and co-existing ADHD—additive effects. J Abnorm Child Psychol 35:79–95PubMedCrossRef

49.

Roessner V, Becker A, Banaschewski T, Rothenberger A (2005) Tic disorders and obsessive compulsive disorder: where is the link? J Neural Transm Suppl 69:69–99PubMed

50.

Rothenberger A, Schmidt MH (2000) Die Funktionen des Frontalhirns und der Verlauf psychischer Störungen. Lang, Frankfurt am Main

51.

Schuerholz LJ, Baumgardner TL, Singer HS, Reiss AL, Denckla MB (1996) Neuropsychological status of children with Tourette’s syndrome with and without attention deficit hyperactivity disorder. Neurology 46:958–965PubMed

52.

Schuerholz LJ, Cutting L, Mazzocco MM, Singer HS, Denckla MB (1997) Neuromotor functioning in children with Tourette syndrome with and without attention deficit hyperactivity disorder. J Child Neurol 12:438–442PubMed

53.

Schultz RT, Carter AS, Scahill L, Leckman JF (1999) Neuropsychological findings. In: Leckman JF, Cohen DJ (eds) Tourette’s syndrome - tics, obsessions, compulsions: developmental psychopathology and clinical care. Wiley, New York, pp 80–103

54.

Shapiro AK, Shapiro ES, Young JG, Feinberg TE (1988) Signs, symptoms, and clinical course. In: Shapiro AK, Shapiro ES, Young JG, Feinberg TE (eds) Gilles de la Tourette Syndrome. Raven Press, New York, pp 127–193

55.

Sherman EM, Shepard L, Joschko M, Freeman RD (1998) Sustained attention and impulsivity in children with Tourette syndrome: comorbidity and confounds. J Clin Exp Neuropsychol 20:644–657PubMedCrossRef

56.

Shin MS, Chung SJ, Hong KE (2001) Comparative study of the behavioral and neuropsychologic characteristics of tic disorder with or without attention-deficit hyperactivity disorder (ADHD). J Child Neurol 16:719–726PubMed

57.

Silverstein SM, Como PG, Palumbo DR, West LL, Osborn LM (1995) Multiple Sources of Attentional Dysfunction in Adults With Tourette’s Syndrome: Comparison With Attention Deficit–Hyperactivity Disorder. Neuropsychology 9:157–164CrossRef

58.

Sonuga-Barke EJ, Houlberg K, Hall M (1994) When is “impulsiveness” not impulsive? The case of hyperactive children’s cognitive style. J Child Psychol Psychiatry 35:1247–1253PubMedCrossRef

59.

Spencer T, Biederman J, Coffey B, Geller D, Faraone S, Wilens T (2001) Tourette disorder and ADHD. Adv Neurol 85:57–77PubMed

60.

Spencer TJ, Biederman J, Faraone S, Mick E, Coffey B, Geller D, Kagan J, Bearman SK, Wilens T (2001) Impact of tic disorders on ADHD outcome across the life cycle: findings from a large group of adults with and without ADHD. Am J Psychiatry 158:611–617PubMedCrossRef

61.

Stroop JR (1935) Studies of interference in serial verbal reactions. J Exp Psychol 28:643–662CrossRef

62.

Sukhodolsky DG, Scahill L, Zhang H, Peterson BS, King RA, Lombroso PJ, Katsovich L, Findley D, Leckman JF (2003) Disruptive behavior in children with Tourette’s syndrome: association with ADHD comorbidity, tic severity, and functional impairment. J Am Acad Child Adolesc Psychiatry 42:98–105PubMedCrossRef

63.

van Mourik R, Oosterlaan J, Sergeant JA (2005) The Stroop revisited: a meta-analysis of interference control in AD/HD. J Child Psychol Psychiatry 46:150–165PubMedCrossRef

64.

Verte S, Geurts HM, Roeyers H, Oosterlaan J, Sergeant JA (2005) Executive functioning in children with autism and Tourette syndrome. Dev Psychopathol 17:415–445PubMedCrossRef

65.

Verte S, Geurts HM, Roeyers H, Oosterlaan J, Sergeant JA (2006) The relationship of working memory, inhibition, and response variability in child psychopathology. J Neurosci Methods 151:5–14PubMedCrossRef

66.

Yeates KO, Bornstein RA (1994) Attention deficit disorder and neuropsychological functioning in children with Tourette’s syndrome. Neuropsychology 8:65–74CrossRef

67.

Yeates KO, Bornstein RA (1996) Neuropsychological correlates of learning disability subtypes in children with Tourette’s syndrome. J Int Neuropsychol Soc 2:375–382PubMedCrossRef

68.

Yordanova J, Dumais-Huber C, Rothenberger A (1996) Coexistence of tics and hyperactivity in children: no additive effect at the psychophysiological level. Int J Psychophysiol 21:121–133PubMedCrossRef

69.

Yordanova J, Dumais-Huber C, Rothenberger A, Woerner W (1997) Frontocortical activity in children with comorbidity of tic disorder and attention-deficit hyperactivity disorder. Biol Psychiatry 41:585–594PubMedCrossRef

70.

Yordanova J, Heinrich H, Kolev V, Rothenberger A (2006) Increased event-related theta activity as a psychophysiological marker of comorbidity in children with tics and attention-deficit/hyperactivity disorders. Neuroimage 15:940–955CrossRef

71.

Zaparniuk J, Taylor S (1997) Impulsivity in children and adolescents. In: Webster CD, Jackson MA (eds) Impulsivity: Theory, assessment, and treatment. Guilford, New York, pp 158–179

Title: Executive functions in children with chronic tic disorders with/without ADHD: new insights
Authors: Dr. Veit Roessner
Andreas Becker
Tobias Banaschewski
Aribert Rothenberger
Publication date: 01-07-2007
Publisher: Steinkopff-Verlag
Published in: European Child & Adolescent Psychiatry / Issue Special Issue 1/2007
Print ISSN: 1018-8827
Electronic ISSN: 1435-165X
DOI: https://doi.org/10.1007/s00787-007-1005-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Executive functions in children with chronic tic disorders with/without ADHD: new insights

Abstract

Objective

Method

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Method

Results

Conclusions

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