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As Time “Tics” Away, Neuroscientists Discover More and More Each Day…

July 26, 2012 – 1:38 pm
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As part of their normal development, young children often engage in ritualistic, repetitive and even compulsive activities. Early developmental phases in humans typically involve perfectionism, attachments to favourite objects, rituals for eating, hoarding, bedtime rituals, etc. Psychologists believe that this phase and its accompanying behaviours help to reduce anxiety and help children organize, adapt to and master their environments.

Langen, a Danish psychiatrist, and his colleagues note the striking similarity between this early phase of development and the ritualistic, compulsive behaviour observed in disorders like OCD, TS and Autism. They main difference is that in early development repetitive behaviour is adaptive and in brain-based disorders like TS it causes significant impairment.

Humans aren’t the only species prone to repetitive behaviour. Repetitive behaviour is normal for several animals including birds, invertebrates, lower mammals and even, some higher mammals. While some animal repetitive behaviours or habits are innate, like mating behaviour, others, like bird songs, are learned.

For humans in fact, most of our behaviours are routine- and habit- based. Ann Graybiel, a PhD at the McGovern Institute for Brain Research, notes that “…during much of our waking lives we act according to our habits, from the time we rise and go through our morning routines until we fall asleep after evening routines.” Graybiel suggests that there is a common theme across animals, children, and adults with disorders like OCD and TS: the repetitive behaviour, motor or cognitive, may be built up (at least in part) through the action of the basal-ganglia-based neural circuits. In other words, it is possible that the repetitive behaviour in question is caused by same thing within the brains of both animals and people.

So what?

Well, as neuroscientists and neurobiologists learn more about what happens in the brain circuitry to cause repetitive behaviour, they come closer to generating pharmacological strategies for reducing harmful types of repetitive behaviour, like SIBs or “self-injurious behaviours.” Put another way, neuropsychiatrists A. M. Meuhlmann & M. H. Lewis note that “we can use available information from clinical and animal models to make more precise hypotheses regarding the pathophysiology driving SIB.”

If this doesn’t make you optimistic. Consider that there is no shortage of neuroscience programs at the university and colleges level and there are several research institutes devoted to treating and understanding neurological conditions. For example, the mission statement of St. Mary’s of Michigan Field of Neuroscience Institute is “to keep the light of progress burning bright in the battle against neurological disease.” Similarly, the Center for Brain Science at Harvard University is devoted to “understanding how neural circuits underlie neurological and psychiatric disorders.”

And advancements have already been made…

In 2011, researchers from the University of Nottingham discovered that the brains of children with TS develop in a unique, particular way that could suggest new methods of treatment. They realized that children with TS perform behavioural tests of cognitive motor control more accurately and quickly then their neuro-typical peers.

Why?

Children with TS have enhanced control due to structural and functional changes in their brains that most likely result from constantly suppressing tics. Using brain scans, the research team found that the Tourette brain has alterations in white-matter connections that allow different brain areas to communicate with each other. They believe that the Tourette brain reorganizes to help control the motor and vocal tics.

One of the researchers behind this study, Stephen Jackson, told media: “Children growing up with a neurological disorder may develop adaptive changes in the way their brain is organized that help them overcome their difficulties and gain control over their symptoms.” This is a possible explanation for the decrease in tic symptoms experienced by individuals with TS as they age.

But what about those whose symptoms persist throughout adulthood?

Well, Jackson says that is could be that some people are just born with the propensity or capacity to develop particular brain white-matter connections that allow them to gain control over tics and others do not. This is the subject of his team’s next study.

The implications of these findings are many. Most importantly, these findings suggest that “brain-training approaches” may help individuals with TS gain control of their symptoms.

Sounds promising…

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General Resources

Not Enough Data for Accurate Estimate of TS Incidence: Dr. Tamara Pringshiem

July 24, 2012 – 2:12 pm
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Dr. Tamara Pringsheim

Hot off the presses is “Prevalence of Tic Disorders: A Systematic Review and Meta-Analysis,” an article published in the journal Paediatric Neurology by several physicians, including Dr. Tamara Pringshiem. Dr. Pringshiem is a member of the Tourette Syndrome Foundation of Canada’s Professional Advisory Board. The TSFC community has the chance to hear Dr. Pringshem speak at the upcoming National Conference in October where she will present on the latest treatment guidelines for TS.

Dr. Pringshiem’s recent article focuses on the problem of under-diagnosis of TS and other tic disorders. The under-diagnosis of TS is a complex issue. Many people with TS are unaware that they have the condition. One study even puts the percentage of people who do not know they have TS at 30%. Tics can, and often are, suppressed or disguised in public. Additionally, they often decline with age. On top of that is the problem of people hiding the fact that they have TS due to fear of social stigma. All these factors combined make it extremely difficult to get an accurate estimate of the prevalence of the condition in the Canadian population.

Rather than relying on one or two studies to establish the current prevalence, Dr. Pringshiem and her colleges examined several different incidence studies in order to obtain the most accurate estimate possible.

Their main findings were:

  • Tic disorders, including TS, are more common among children than adults; and more common among males than females.
  • Tic disorders are more common in special education settings, among those receiving institutionalized care, and among those with Autism.
  • The most common type of tic disorder is transient tic disorder (approximately 2.99%), followed by chronic tic disorder.
  • TS is the third most common tic disorder.
  • There is no consensus among experts about the prevalence of TS and other tic disorders.
  • According to most school-based studies, 2-11 people out of every 1000 have TS.
  • The highest numbers, reported in three academic studies, put the incidence of TS at 3.8%. The lowest reported prevalence was 0.1%.
  • Very few studies focus on figuring out how many adults have TS.
  • Because the definition of TS has changed over time, prevalence hasn’t been consistently measured from study to study.
  • There is no current Canadian prevalence data; instead, incidence studies primarily focus on American and Western European populations.

Dr. Pringshiem and her colleagues recommend more studies on the prevalence of TS and other tic disorders. They also argue for the simplification of how we classify tic disorders. Making TS, chronic motor tic disorder, and chronic vocal tic disorder separate and distinct conditions, Pringshem et al. contend, is of “debatable value” because there are so few differences in the conditions and in how they are treated.

Perhaps as the TS community is more and more successful at eliminating stigma, more people will feel comfortable being “out” about their condition. As we as a country become more aware of the condition, those who do not know they have TS will come to understand why they do what they do. In time, perhaps, new studies may come to better understand the actual prevalence of condition in Canada. For now, we have to make do with only a few studies of the US and Europe and try to remember that the actual prevalence of TS is likely much higher than our best guess.

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Resources

Is Exercise Good for Your Mental Health?

July 17, 2012 – 3:38 pm
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If you have TS, you may also have another condition like as anxiety, depression, Attention Deficit/Hyperactivity Disorder, or Obsessive Compulsive Disorder. These conditions are treatable in most cases, through a regiment of either therapy and/or medication. But what about exercise?

We know that exercising regularly is good for our physical health; does it help with mental health as well? What does the research say? Read on to learn more.

Depression & Exercise

Depression is an extremely common condition, and not surprisingly, research strongly points to possible effects of exercise on depression. Several academic studies conclude that exercise is a good preventative strategy in that it helps reduce the risk of depression in both adolescents and adults. One Netherlands-based study based even found that it doesn’t take much to reap the mental benefits of physical fitness. The study found that for people with physically undemanding jobs, like an office job, all it takes to reduce the risk of depression and emotional exhaustion is strenuous exercise once or twice a week.

Exercise helps to prevent depression, but can it also be used to treat the condition? According to a recent analysis of several studies on this topic, there is not enough high quality research to support the claim that exercise reduces depression symptoms. However, there are some preliminary supportive findings, so it may very well be that exercise does help.

Does exercise also help with other mental health conditions?

According to PhDs Jerome Sarris, David Camfield and Michael Berk, the answer is possibly. In their 2011 article, “Complementary medicine, self-help and lifestyle interventions for OCD,” the authors say that there is some evidence that exercise can help reduce obsessions and compulsions, but not enough to make a firm conclusion.

Gapin et al. (2011) came to a similar conclusion in their study of exercise and ADHD. They found some evidence that exercise helps with behaviour and cognitive functioning in people with ADHD, but they were ultimately inconclusive.

Another interesting question is whether people with mental health challenges actually want to exercise. According to Mind, a UK charity, 83% of individuals with mental health problems use exercise to improve their mood and/or reduce stress and two-thirds of them say that exercise helps their condition.

The science

So how does this work exactly?

Well, exercise increases the flow of blood to the brain, causing the release of endorphins, a mood-enhancing chemical. Norepinephrine, dopamine, and serotonin—all mood-lifting chemicals that usually decrease during depression—also increase when we exercise.

Some studies suggest that there is a link between levels of brain-derived neurotrophic factor or BDNF, (another mood-enhancer) and exercise. There is also some recent evidence suggesting that exercise can increase brain plasticity meaning that it can improve cognitive functioning.

Psychologists add that exercise improves mood because it increases a person’s sense of physical self-worth, self-esteem and gives people a more positive body image.

How to Get Exercising Today

  • Getting fit isn’t as complicated or as costly as you may think. You can bike, run or walk outside—for free! To start with, try walking or biking to work or school
  • You will likely find reasonably priced fitness programs offered by your local YMCAs and community centres if you are willing to spend some money
  • Keep your eyes peeled for special deals! For example, Good Life Fitness is currently offering their facilities to teens for free this summer!: http://www.goodlifefitness.com/teenfitness/

To learn more about physical fitness, check out the Public Health Agency of Canada’s website and online fact sheets: http://www.phac-aspc.gc.ca/hp-ps/hl-mvs/pa-ap/index-eng.php

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Children/Youth Resources

Terrible Twos or Terrible Parenting? Raising a Child in the New Millennium

July 10, 2012 – 10:40 am
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Most of us have heard of the terrible twos, or at least acknowledge that toddlers can be quite difficult to manage at times. Temper tantrums, noncompliance, aggression, these are widely accepted as just part of being a kid. It comes with the territory, or does it?

When does a toddler have a conduct or disruptive behaviour disorder, and when are they just being a toddler? This was the subject of psychologist Kim Renk’s article, “Disorders of conduct in young children: Developmental considerations, diagnoses, and other considerations.”

The toddler years are an extremely important period in a person’s life. Psychologist Alison Gopnik, author of The Philosophical Baby and The Scientist in the Crib, likens early childhood to a butterfly and adulthood to the caterpillar phase because of humans’ rapid developmental gains in their early years. Gopnik’s work explores how tiny infants develop using processes of learning similar to those of the modern scientist such as experimenting on their environment.

Is that why babies and toddlers get so cranky sometimes?

Renk says, “Unfortunately for parents, as toddlers are testing their sense of independence, they also exhibit an increase in negativity and oppositionality.” Not surprisingly, conduct disorders are the most common reason why preschoolers are referred to psychologists. Renk argues that mental health professionals need to be aware of the fact that “noncompliance co-occurs with young children’s increasing sense of self and because young children have difficulty understanding adults’ expectations,” not necessarily because they have a conduct disorder.

It is only when behaviour impairs functioning that a clinical diagnosis should be considered, cautions Renk. Impaired functioning includes angry defiance, difficulties in the parent-child relationship and/or difficulties with development, all of which are out of the ordinary. Any behaviours that interfere with the development of age-appropriate skills including communication and interpersonal skills are of concern.

What should parents or caregivers do with a disruptive, oppositional youngster? Renk says that they should set limits and provide support. Toddlers often give an “automatic no” response that can be frustrating. In response, parents should provide clear explanations and expectations with warmth and lots of positive encouragement.

According to researchers, the quality of parenting that children experience is extremely significant for their development, well-being, and life opportunities. This is why psychologist Matthew Sanders recommends a parenting model called “Triple P.” This model aims to prevent severe behavioural, emotional and developmental problems in children and adolescents by enhancing the skills, knowledge and confidence of parents. The model includes a series of interventions and supports for parents at each stage in their child’s development such as parenting seminars and telephone consultations. To learn more about Triple P in Canada visit www9.triplep.net.

This brings us to the question: is there such a thing as bad parenting? Except in clear cases of child abuse, this is a hotly debated issue. Authoritarian parenting is one form of parenting that has come under scrutiny recently. This parenting is low in responsiveness and warmth and high in coercive control, using physical punishment and verbal hostility as disciplinary strategies. Academic studies find that it is associated with children’s aggressive and disruptive behaviour at school.

At the other end of the parenting spectrum is “helicopter parenting.” Children of helicopter parents, the so-called “Millennials,” were born between 1982 and 1995. They are thought to be the most protected generation in history—they grew up in childproofed homes, wore bike helmets and did highly structured activities. Their parents use cell phones, or “the electronic umbilical cord,” email and social networking sites to perpetually check on them.

Helicopter parents are thought to experience separation anxiety when their children leave the family home, and they often micromanage their children’s lives. One 2011 study attempted to isolate the effects of this type of parenting. The authors’ results “suggest that helicopter parenting is negatively related to psychological well-being and positively related to prescription medication use for anxiety/depression and the recreational consumption of pain pills.” However, the authors note that were some limitations to their study and that there needs to be more research on the subject.

What is your parenting style? What do you think about authoritarian parenting and/or helicopter parenting?

Click here to read a TIME article on helicopter parenting.

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Resources Tic Treatments

Does BOTOX help with tics?

July 5, 2012 – 10:48 am
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Recently, several TSFC members asked National Office staff about the use of BOTOX injections as a tic treatment. In response, the TSFC did some research and here is what we found.

In the current clinical guidelines for treating Tourette Syndrome, BOTOX has a “weak recommendation” due to the low quality of medical evidence in favour of the treatment.  The authors state that:

While the consensus group believes that botulinum toxin injections are generally safe and without systemic side effects, we recommend using this treatment in only very specific situations. Botulinum toxin injections should be considered for the treatment of severely disabling vocal tics, such as coprolalia, or very distressing motor tics involving the upper face or neck. Further, only an experienced clinician should administer botulinum toxin injections.

What do studies about the treatment indicate?

In 2000, an article published in the Archives of Neurology called, “Botulinum Toxin in the Treatment of Tics,” evaluated the effectiveness and safety of BOTOX injections in the treatment of tics in patients with TS.

In their background research, the authors noted that Botulinum toxin (BTX) has been successfully used to treat conditions with abnormal and involuntary movements. They followed 35 patients with TS (30 male and 5 female) who ranged in age from 8-69 years old. These patients had 115 treatment sessions in total, with the majority receiving the injection in the upper face muscles, eyelids, and the ceverical muscles.

The results?

29 of the 35 patients experienced improvement in their tics;  84% of the patients also experienced improvement in their premonitory sensations. 5 patients experienced a tic-free period of greater than 1 year at the injection site, 3 of these five patients were injected only once. Side effects included: 1. some neck weakness lasting an average of 23 days (in 4 patients); 2. ptosis or drooping of the eyelid lasting 28 days (in 2 patients); 3. generalized weakness lasting 7 days (in 1 patient); 4. non-disabling dysphagia or swallowing difficulty lasting about 17 days (in 2 patients); 5. fatigue lasting for 14 days (in 1 patient) and 6. nausea and/or vomiting lasting 1 day (in 1 patient).

The authors concluded, “The findings of this study of 35 patients support the use of BTX injections as a safe and effective treatment for tics”.  However, the authors also noted that they were not sure if the patients who experience remission did so due to the treatment or coincidence. They also noted, “our study has several shortcomings and, therefore, the results must be interpreted cautiously.”

A subsequent 2004 study examined BOTOX treatment for phonic tics in TS patients. In this study, 30 patients received BOTOX injections in their vocal cords. 93% of patients found that their tics improved after the treatment, 50% were tic-free. Prior to the treatment 53% of the patients reported a premonitory sensation, after the treatment, this number decreased to 20%. The average response time to the treatment was 5.8 days with a range of 1-20 days. Patients noted an improvement for an average of 100 days with a range of 20-300 days. The only side effect experienced was hypophonia or weak voice due to lack of coordination of the vocal muscles. 24 subjects experienced this side effect for about 10 days. The authors concluded: “We consider that this treatment should be used more widely in the management of patients with phonic tics, particularly in patients who have poor compliance with drug regiments.”

The results of these two studies were replicated in a 2010 article published in Parkinsonism and Related Disorders. The authors concluded that “this study strongly suggests that treatment with BTX-A is effective in most patients with simple motor tics and retains its efficacy after long-term treatment.” The authors also point out that there were some limitations to their study due to their study design.

The study did find that were several side effects. For one patient, once her eye-blinking tic went away, she developed a sniffing tic which she found to be more socially challenging than the eye-blinking tic. Another patient experienced flu-like symptoms in the weeks following the injection, and felt that these symptoms grew stronger with each subsequent therapy. However, after ten treatments the flu-like symptoms resolved completely. Another patient experienced congestion for 2-4 weeks after injection in the ocular muscles. Muscle weakness and loss of facial expression were each noted once in different patients.

Another question often asked is whether BOTOX as a tic treatment is covered by public health insurance plans. According to the Canada Revenue Agency, “botulinum injections are only a [covered] medical expense if it is necessary for medical and reconstructive purposes such as surgery to address a deformity related to a congenital abnormality, a personal injury resulting from an accident or trauma or a disfiguring disease.” Some private health care plan might cover the treatment.

To learn more about this treatment, talk to your treating physician.

If you received this treatment and want to share your experience, please leave a comment below. If you would like to share your story anonymously, send it via email to tsfc@tourette.ca and we will post it to the site without any authoring name.

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Children/Youth Resources SID

“Sensory What-egration?”: The 411 on Sensory Integration and Sensory Processing Dysfunction

July 3, 2012 – 11:11 am
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Recently, the National Office received several questions about sensory integration dysfunction (SID), a common co-occurring condition with TS.

Just last week, a parent asked a National Office staff member if SID was a “real thing.” The National Office staff member assured her that it is real, however there is some debate in the medical community about whether it is a stand alone condition or a symptom of other conditions. The concerned parent asked where she could go for help with treatment and diagnosis. If you are in the same position and what to learn more, please read on.

Below are some FAQs on sensory integration and sensory processing dysfunction.

What is sensory integration?
Sensory integration is using senses to understand the world around us, or “the organization of sensation for use.” It refers specifically, to the ability of the brain to filter and process incoming information from all the body’s senses or sensory systems.

What are sensory systems?
Sensory systems include touch, taste, smell, sight and hearing as well as “vestibular” or movement, and “proprioceptive,” which refers to the info you gain through receptors in your joints and muscles.

What is sensory integration dysfunction?
Each of the body’s sensory systems work together to ensure that a person can successfully interact with, and make sense of, the world around them. A problem or disruption in this process is called sensory processing dysfunction.

What causes it?
The cause is not entirely clear. It may include genetic, hereditary, environmental factors, but the exact cause continues to be studied. So far, scientists have had some success in linking structural and chemical imbalances in the brain to the body’s uncharacteristic or disproportionate response to sensory stimuli.

What is the impact of having this condition?
It can affect a child’s gross and fine motor development, coordination, balance, and visual, perceptual and self-help skills. As a result, a child who has difficulty in these areas can have additional problems engaging in everyday activities. According to a 2011 study published by the National Institute of Neurological Disorders and Stroke, people with TS often find that their sensory processing challenges are equally or more disruptive than their motor tics. The study also notes that sensory sensitivity has a substantial negative impact on quality of life.

How is SID diagnosed?
This is a challenging clinical issue. Sensory processing disorder or dysfunction is included in several diagnostic manuals like the Diagnostic Manual for Infancy and Early Childhood of the Interdisciplinary Council on Developmental and Learning Disorders as well as Zero to Three’s Diagnostic Classification of Mental Health and Developmental Disorder of Infancy and Early Childhood Revised. Some experts argue that it should be included in the Diagnostic and Statistical Manual of Mental Disorder. The committee that prepares this textbook has requested more studies about the condition. Studies to date have yet to demonstrate that sensory integration dysfunction exists as separate from other developmental disabilities. So currently, rather than be diagnosed as a disorder, it is treated as a symptom of another disorder.

What is a modulation disorder? Is it the same thing?
Yes. It is sometimes called a modulation disorder to reflect the fact that it involves the inability to regulate responses to sensory input.

Can you give an example what it is like to have sensory processing dysfunction?
Jordan is three years old. He does not like being near other children in preschool, he hides in the corner during circle time, he refuses to play with messy things like play dough and rice and beans in the counting centre. He is thin because he will only eat soft, mushy food and hates to touch any foods that are crunchy or chewy. Jordan has a hard time participating in age appropriate activities in his preschool class and exhibits delays in fine and gross motor skills as well as social skills. Jordan has sensory integration dysfunction.

What kind of treatment is available?
Sensory-based therapies, such as sensory integration therapy, are used by occupational therapists and sometimes by other therapists to treat children with sensory challenges. These therapies involve activities that are believed to organize the sensory system. It includes the use of brushes, swings, balls and other recreational equipment. Occupational therapy with the use of sensory-based therapies is one component of a comprehensive treatment plan.

What are some classroom strategies for helping a student with SID?
There are many types of sensory processing dysfunction, and as a result, there are many types of strategies. For example, some children have tactile system problems, meaning that their tactile system does not correctly interpret and understand what kind of touch is threatening or harmful and what kind of touch is playful or safe. Instead, they may have “tactile defensiveness.” They may scream and run away in response to being accidentally brushed on the arm by a classmate because they perceive the touch as painful or deeply uncomfortable. Alternatively, they may have “tactile hyposensitivity” and cannot get enough touch. As a result, they touch everyone and everything, and have an unusually high pain threshold among other symptoms. One strategy for teaching a child with this type of sensory dysfunction is to offer them less threatening tactile experiences like touching paper or cloth. Reducing expectations is also recommended. For example, rather than having them finger paint, perhaps they are only asked to stand near others finger painting, this may be all they can cope with.

What do I do if I think that either my child or I have sensory processing dysfunction?
Contact your family doctor, treating neurologist or paediatrician and discuss the challenges you are experiencing. You should not try to treat it yourself. Come up with a treatment plan with your doctor and obtain any necessary referrals to other specialists or professionals.

If you have other questions or comments about this or other disorders associated with Tourette Syndrome, please contact the National Office at tsfc@tourette.ca or 1-800-361-3120.

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Children/Youth Resources

Thinking About a Summer Camp for Your Young One?

June 29, 2012 – 12:03 pm
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School’s out, the weather is beautiful, and your child probably has a lot of time on their hands. The good news is that summer camps are great for stimulating young minds, getting physical activity, meeting other kids and making friends, connecting with nature and so much more. The bad news is that for some kids with TS, and especially those with TS plus, generic summer camps can present challenges. Challenges include kids who are not very understanding or respectful of TS, counsellors who are not trained to correctly respond to aspects of TS plus, and so on. You don’t want your young one to have a bad experience. Thankfully many camps exist that specialize in kids with special needs, even those that cater to kids with TS specifically. Below are a few of them. Bear in mind that some, such as Camp Winston, have long waiting lists. Others are currently open to registration.

If you know of any such camps in your area, please let us know so that we can add them to this list. You can either leave a comment here or send an email to ken@tourette.ca. The TSFC would like to wish you and your young one a happy and safe summer. Have fun!

Camps in Alberta

Tourette Adventure Camp (July 2012)
TSFC Edmonton Chapter Day Camp for kids ages 8-10 (July 2012)
TSFC Edmonton Chapter Day Camp for kids ages 11-13 (July 2012)

Camps in BC

Eureka Outdoor Camp

Camps in Ontario

Camp Concord
Camp Kennebec
Camp Kirk
Camp Kodiak
Camp Prospect
Camp Tamarack
Camp Winston
Camp Zodiac
New Stride Day Camp
Ontario Pioneer Camp

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OCD Resources

Is CBT* the Right Treatment for Your OCD?

June 28, 2012 – 10:50 am
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Obsessive Compulsive Disorder (OCD) is a chronic anxiety condition that is often found in people with Tourette Syndrome. It is so common in fact, that studies indicate that 60% of people with TS also have OCD. This makes OCD the most common co-occurring “+” in TS+ alongside ADHD.

OCD symptoms include obsessions, or recurrent thoughts or mental images; and compulsions, acts aimed at reducing anxiety (even if they are not logically connected with the anxiety or fear). Common obsessions include fear of germs, desire for cleanliness, and wanting everything to be “just right.” Common compulsions include repeated hand-washing, repetitive counting, lining up clothes by colour, and constantly checking that you locked the door. There are many other types of obsessions and compulsions, too many to list here.

OCD is a medical condition; it is not simply about being fixated on something. For example, checking once or twice that you locked the front door or turned off the curling iron does not mean you have OCD. OCD involves obsessions and compulsions that significantly impair day-to-day functioning. For example, if you can’t get to work on time because you need to wash your dishes over and over, or you can’t sleep until you wash the floor three times daily to the point that you are unable to get a full night’s rest, this may be OCD. If you think you have OCD, do not self-diagnose and/or self-treat, see your doctor and tell them why you think you may have this condition.

To date the most effective psychological treatment for OCD is Cognitive Behavioural Therapy (CBT) with Exposure and Response Prevention or (E/RP). E/RP involves confronting fears and learning to discontinue your natural escape response that usually follows the confrontation. Cognitive Behavioural Therapy involves learning to replace negative thinking and over-generalizing with positive, effective, and realistic thinking with the end goal being decreased emotional distress and decreased self-defeating behaviour.

Several studies find that the use of CBT, even in extremely severe OCD cases, can lead to clinically significant improvements in symptoms. However, some studies also find that many individuals still experience some symptoms rather than a “full recovery” or “remission” after doing CBT. Unfortunately, CBT and E/RP can be costly when they are not covered. They are also extremely time-consuming since they require many months of frequent therapy sessions in order to be successful.

It is for these reasons that two Australian doctors examined exactly what factors are associated with successful CBT treatment outcomes in OCD patients. They published their findings in 2011 in the Journal of Counselling and Psychotherapy.

What did they discover?

First of all, they concluded that: “predicting the CBT outcome in adult OCD is difficult.” Gender, how long a person had OCD, age of onset, and whether or not they had other co-occurring psychological conditions like anxiety or depression, was not related to treatment outcomes.

For the most part, treatment success was also unrelated to the type of obsession and/or compulsion, except for sexual obsessions, which they found to be associated with poorer treatment results.

Another factor they found to be associated with poorer treatment outcomes was severity of symptoms. Their study showed that if a person began CBT treatment with extremely severe symptoms, they were the more likely to conclude treatment with some severe symptoms.

A word of caution: the authors noted that their results are consistent with another study that found that more severe OCD is associated a poorer treatment outcomes. However, they pointed out that a different study found contradictory results.

Due to this contradiction they stated, “lack of consistency in the research…makes targeting specific treatments at those most likely to improve a difficult [task]”. As a result, they concluded, “CBT-based treatment for OCD should be recommended for all individuals with the condition.”

If you think you or a loved one may have OCD, talk to your family doctor about it. They can help refer you to a practitioner who can administer CBT. You should not receive CBT from someone who is not a licensed professional like a physician or psychologist.

If you would like a name and phone number for a licensed CBT professional in your area, call or email the National Office at 1-800-361-3120 or tsfc@tourette.ca.

Have you ever had CBT? What was it like? Did it help? Share your stories in the comments.

*CBT stands for Cognitive Behavioural Therapy. If you would like more information on CBIT, which stands for Cognitive Behavioural Intervention for Tics, please read about it here or call or email the National Office at tsfc@tourette.ca or call us at 905-673-2255 or toll free at 1-800-361-3120.

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ADHD Children/Youth Resources

ADHD: to Medicate or Not to Medicate, Still a Question?

June 20, 2012 – 12:04 pm
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Does your son or daughter have ADHD? If so, you are not alone. ADHD affects between 3-8% of school-aged children and 75% of youth with Tourette Syndrome. It is the most common co-occurring condition with TS along with Obsessive Compulsive Disorder (OCD).

Does your son or daughter take medication for their ADHD? Have you struggled with whether or not to allow them to take ADHD medication? Do you worry about whether taking medication for ADHD is a good idea? Again, you are not alone. Medical professionals are debating the same issue.

In January, psychologist Alan Srouffe wrote an Op-ed in the New York Times called “Ritalin Gone Wrong.”

He said “no study has found any long-term benefit of attention-deficit medication on academic performance, peer relationships or behaviour problems.” Instead, he reported, the benefits of the medications fade with time.

Srouffee says that people have ADHD not just because of genetics, but also because of particular environments. Environmental factors that can cause ADHD, Srouffe writes, include lack of social support, chaotic living situations, and “especially, patterns of parental intrusiveness that involve stimulation for which the baby is not prepared.”

Srouffe worries that ADHD meds do not fix these environmental factors which cause the problem in the first place. He concludes that “large-scale medication of children feeds into a societal view that all of life’s problems can be solved with a pill.” He also writes that: “the illusion that children’s beahivour problems can be cured with drugs prevents us from seeking the complex solution…”

On June 9th, 2012, physician Leonard Sax agreed in another NY Times Op-ed about ADHD meds.

Sax authored “Boys Adrift: The Five Factors Driving the Growing Epidemic of Unmotivated Boys and Underachieving Young Men.” He writes: “The next time you hear a doctor say, with a regard to proscribing stimulant medications, ‘let’s try and see whether it helps,’ I suggest you run.” The medications he is referring to include Focalin, Metadate, Concerta, Adderall, and other stimulants used to treat ADHD.

So where is the debate, you ask? Well, read on.

On June 11th, Tanaya Froehlich, professor of developmental and behavioural paediatrics, disagreed. She says that while some patients are being treated inappropriately with ADHD meds, there is also evidence that some groups are under-diagnosed and undertreated. These groups include girls and the poor. She also writes that while ADHD meds do not work for every child, they “may confer important benefits” for some. Froehlich concludes: “our focus should be on increasing rigor in ADHD evaluations, rather than on blinding reducing medication use.”

Check out this video from NBC news that presents both sides of the debate.

Tell us what you think about medicating for ADHD: is it medically necessary or overprescribed?

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Is There a Connection between TS+ and Alcohol/Substance Abuse?

June 14, 2012 – 2:55 pm
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Does having TS or ADHD mean a greater likelihood of alcohol/substance abuse?  Read on to find out what recent research says about the risk factors.

A study published this year found that most substance abuse problems peak during ages 18-26. This is when individuals go through rapid transitions, enter new social contexts, and have greater freedoms. That said, there are other reasons besides turning 18 that make someone more or less likely to abuse alcohol.

It is important to understand these “risk factors” as they are indicators of a higher likelihood that a person will develop an addiction to alcohol/drugs or use alcohol/drugs.

Risk Factors:

1. Gender

Males are more likely to abuse and use alcohol and marijuana than females.

2. Parental or Family Drinking, Family Medical History

If a pregnant woman drinks three plus glasses of alcohol per day, her child is likely to develop adult alcohol disorder. A family history of alcoholism is also a risk factor for alcoholism. Parental depression, like a family history of alcoholism, is associated with higher rates of alcohol abuse in children and youth.

3. Genetics & Social Factors

Substance dependence is associated with a number of genetic variations, but no one gene variant accounts for substance abuse. Genetic risks of alcoholism interact, or combine with, behavioural and social factors to impart a certain level of risk on a particular individual. For example, living in a more unstable neighbourhood is associated with a higher risk of young adult alcohol, drug and nicotine disorders. Individuals who experience abuse in childhood are also at a higher risk of becoming addicted to alcohol and abusing other harmful substances. In contrast, strong family bonds predict lower alcohol abuse and consumption. Social norms also play a role in drinking habits. For example, evidence suggests that in college, peers often accept binge drinking and so more binge drinking occurs.

4. Hyperactivity

Child hyperactivity is linked to young adult alcohol/drug problems only if it co-occurs with other conditions like oppositional defiance disorder, conduct disorder, anxiety or depression. In males, there is a strong link between youth aggression and young adulthood problem drinking.

5. Depression or Anxiety Disorders

Having some depressive symptoms in adolescence is a substance abuse risk factor. However, having a major depressive disorder is not a predictor of alcohol abuse. In fact, child (age 10-11) depressive symptoms predicted less of a tendency to drink. The is likely a result of doctor’s orders.

Having psychiatric symptoms (like anxiety or depression) at age 19 predicts greater amounts of heavy drink at age 25 than someone without these psychiatric symptoms. Delinquency, deviance, antisocial behaviour, and conduct problems predict heavier alcohol use in early and late adulthood.  Sensation-seeking behaviour and low harm avoidance behaviour in childhood and adolescence is associated with high drug and alcohol consumption in later life.

6. Other

Poor grades, low attachment to school, stressful life events (like a death of a parent) are predictors of alcohol abuse in young adulthood.

Note: Having these risk factors does not mean that a person will have an alcohol or substance abuse problem. These factors indicate that a person is more likely than those who do not have the same risk factors to develop these problems.

Statistics:

  • According to CBC News, Canadians spent almost $700 dollars on alcohol per person on average in 2007.
  • A 2008 study from the Canadian Centre for Addiction and Mental Health estimates that alcohol abuse costs every Canadian $463 per year in lost productivity, health care costs, and crime related costs.
  • Mothers Against Drunk Driving estimate that every year 1,500 deaths occur due to drunk driving.
  • Per capita, Canadians consume on average, 115.75 litres of alcohol every year.
  • Alcohol sales totalled $18 billion dollars in 2007.

Need Help?

If you or a loved one has a substance abuse problem, please contact your provincial treatment referral service. They should also be able to tell you which programs are supported by your provincial health insurance plan. Here is a list by province/territory:
http://www.ccsa.ca/eng/topics/treatment/default/Pages/default.aspx

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