The impact of a stress induction task on tic frequencies in youth with Tourette Syndrome

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Abstract

Tourette Syndrome (TS) is a neuropsychiatric disorder characterized by motor and vocal tics. Tic fluctuations are common and thought to be attributable in part, to contextual variables. Stress is one such variable, but its effects and mechanism of action are poorly understood. The current study measured the effects of a stress induction task on tic frequencies during periods of suppression and non-suppression of tics. Ten youth with TS between the ages of 9 and 17 were exposed to four conditions in random sequence: free-to-tic baseline (BL), reinforced tic suppression (SUP), reinforced tic suppression plus a stress induction task (SUP + STRESS), and a stress induction task alone (STRESS). Tic frequencies did not differ during STRESS and BL. Tic frequencies were greater in SUP + STRESS than SUP. Stress may impact tics through disrupting suppression efforts. Clinically, results suggest that interventions designed to improve tic inhibition in the presence of acute stressors may be beneficial.

Highlights

► Measured the effects of a stress on tics while suppressing and not suppressing. ► Stress did not make tics worse. ► Stress seemed to diminish suppression ability. ► Treatments should train tic inhibition in the presence of acute stressors.

Section snippets

Participants

Youth (ages 9–17) were eligible to participate if they 1) had a diagnosis of TS or Chronic Tic Disorder (either motor or vocal), 2) had a YGTSS Tic Severity Score of ≥14 for TS and ≥10 for CTD, 3) had at least 1 discernable tic per minute, as observed during the initial assessment, and 4) had a score of ≥80 on the Wechsler Abbreviated Scale of Intelligence. Exclusionary criteria included a history of ≥3 sessions of Habit Reversal Therapy (HRT) or other treatment primarily comprised of

Results

Demographics. Basic demographic information for each participant is presented in Table 1. Participants had a mean age of 12.5 years and a mean WASI IQ score of 103.2 (SD = 12.3). Five children had co-occurring psychiatric diagnoses. Three were currently on psychotropic medication, and all reported stability in medication type and dose (range = 4–38 months). None had previously received behavior therapy for tics.

Tic symptoms and severity. Participants with TS had a mean YGTSS total tic score of

Discussion

Stress has long been implicated as a variable responsible for tic exacerbations; however, this finding largely emerges from studies based on self-report data and uncontrolled methodology. The current study addressed the purported tic–stress relationship by using experimental methodology to test two hypotheses: 1) increased stress would be associated with increased tic frequencies (STRESS > BL), and 2) stress would disrupt tic suppression (STRESS + SUP > SUP).

Results showed that 1) tic

Acknowledgements

This research was supported in part by an American Psychology Foundation COGDOP Graduate Research Scholarship. We would like to thank the participants and their families for their assistance. We would also like to thank Rachel Rebitski and Katie Kaldova for their work on this project.

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