The effects of Gilles de la Tourette syndrome and other chronic tic disorders on quality of life across the lifespan:a systematic review

Gilles de la Tourette syndrome (GTS) and other chronic tic disorders are neurodevelopmental conditions characterized by the presence of tics and associated behavioral problems. Whilst converging evidence indicates that these conditions can affect patients' quality of life (QoL), the extent of this impairment across the lifespan is not well understood. We conducted a systematic literature review of published QoL studies in GTS and other chronic tic disorders to comprehensively assess the effects of these conditions on QoL in different age groups. We found that QoL can be perceived differently by child and adult patients, especially with regard to the reciprocal contributions of tics and behavioral problems to the different domains of QoL. Specifically, QoL profiles in children often reflect the impact of co-morbid attention-deficit and hyperactivity symptoms, which tend to improve with age, whereas adults' perception of QoL seems to be more strongly affected by the presence of depression and anxiety. Management strategies should take into account differences in age-related QoL needs between children and adults with GTS or other chronic tic disorders.

La thérapie cognitive-comportementale dans le traitement du TDAH chez l'adulte: état des connaissances

Essai doctoral présenté à la Faculté des Arts et des Sciences en vue de l'obtention du grade de doctorat en psychologie clinique (D.psy.)

On-line puzzle game based assessment & training for ADHD

Attention-deficit hyperactivity disorder (ADHD) is the most prevalent and impairing neurodevelopmental disorder, with worldwide estimates of 5.29%. ADHD is clinically characterized by hyperactivity-impulsivity and inattention, with neuropsychological deficits in executive functions, attention, working memory and inhibition. These cognitive processes rely on prefrontal cortex function; cognitive training programs enhance performance of ADHD participants supporting the idea of neuronal plasticity. Here we propose the development of an on-line puzzle game based assessment and training tool in which participants must deduce the ‘winning symbol’ out of N distracters. To increase ecological validity of assessments strategically triggered Twitter/Facebook notifications will challenge the ability to ignore distracters. In the UK, significant cost for the disorder on health, social and education services, stand at £23m a year. Thus the potential impact of neuropsychological assessment and training to improve our understanding of the pathophysiology of ADHD, and hence our treatment interventions and patient outcomes, cannot be overstated.

The ecocultural context and child behavior problems: A qualitative analysis in rural Nepal.

Commonly used paradigms for studying child psychopathology emphasize individual-level factors and often neglect the role of context in shaping risk and protective factors among children, families, and communities. To address this gap, we evaluated influences of ecocultural contextual factors on definitions, development of, and responses to child behavior problems and examined how contextual knowledge can inform culturally responsive interventions. We drew on Super and Harkness' "developmental niche" framework to evaluate the influences of physical and social settings, childcare customs and practices, and parental ethnotheories on the definitions, development of, and responses to child behavior problems in a community in rural Nepal. Data were collected between February and October 2014 through in-depth interviews with a purposive sampling strategy targeting parents (N = 10), teachers (N = 6), and community leaders (N = 8) familiar with child-rearing. Results were supplemented by focus group discussions with children (N = 9) and teachers (N = 8), pile-sort interviews with mothers (N = 8) of school-aged children, and direct observations in homes, schools, and community spaces. Behavior problems were largely defined in light of parents' socialization goals and role expectations for children. Certain physical settings and times were seen to carry greater risk for problematic behavior when children were unsupervised. Parents and other adults attempted to mitigate behavior problems by supervising them and their social interactions, providing for their physical needs, educating them, and through a shared verbal reminding strategy (samjhaune). The findings of our study illustrate the transactional nature of behavior problem development that involves context-specific goals, roles, and concerns that are likely to affect adults' interpretations and responses to children's behavior. Ultimately, employing a developmental niche framework will elucidate setting-specific risk and protective factors for culturally compelling intervention strategies.

"I Use Weed for My ADHD": A Qualitative Analysis of Online Forum Discussions on Cannabis Use and ADHD.

BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) is a risk factor for problematic cannabis use. However, clinical and anecdotal evidence suggest an increasingly popular perception that cannabis is therapeutic for ADHD, including via online resources. Given that the Internet is increasingly utilized as a source of healthcare information and may influence perceptions, we conducted a qualitative analysis of online forum discussions, also referred to as threads, on the effects of cannabis on ADHD to systematically characterize the content patients and caregivers may encounter about ADHD and cannabis. METHODS: A total of 268 separate forum threads were identified. Twenty percent (20%) were randomly selected, which yielded 55 separate forum threads (mean number of individual posts per forum thread = 17.53) scored by three raters (Cohen's kappa = 0.74). A final sample of 401 posts in these forum threads received at least one endorsement on predetermined topics following qualitative coding procedures. RESULTS: Twenty-five (25%) percent of individual posts indicated that cannabis is therapeutic for ADHD, as opposed to 8% that it is harmful, 5% that it is both therapeutic and harmful, and 2% that it has no effect on ADHD. This pattern was generally consistent when the year of each post was considered. The greater endorsement of therapeutic versus harmful effects of cannabis did not generalize to mood, other (non-ADHD) psychiatric conditions, or overall domains of daily life. Additional themes emerged (e.g., cannabis being considered sanctioned by healthcare providers). CONCLUSIONS: Despite that there are no clinical recommendations or systematic research supporting the beneficial effects of cannabis use for ADHD, online discussions indicate that cannabis is considered therapeutic for ADHD-this is the first study to identify such a trend. This type of online information could shape ADHD patient and caregiver perceptions, and influence cannabis use and clinical care.

Investigating the developmental and behavioral consequences of maternal immune activation on affected offspring

Maternal infection during pregnancy increases the risk of several neuropsychiatric disorders later in life, many of which have a component of dopaminergic (DA) dysfunction, including schizophrenia, autism spectrum disorders (ASD), and attention deficit hyperactivity disorder (ADHD). The majority of DA neurons are found in the adult midbrain; as such the midbrain is a key region of interest regarding these disorders. The literature is conflicting regarding the behavioral alterations following maternal immune activation (MIA) exposure, and the cellular and molecular consequences of MIA on the developing midbrain remain to be fully elucidated. Thus, this thesis aimed to establish the consequences of acute and mild MIA on offspring dopamine-related behaviors, as well as the associated cellular and molecular disturbances of MIA on offspring midbrains. We utilized a rat model of MIA using low dose (50μg/kg, I.P.) of LPS administered at different gestational ages. Our first study indicated that MIA at later gestational ages significantly increased pro-inflammatory IL-1β expression, and reduced HSD11B2 expression in the placenta, which is an important regulator of fetal development. In utero LPS exposure at later gestational ages also impaired the growth of neurons from affected offspring. This study identified key gestational stages during which MIA resulted in differential effects. We utilized these time points in subsequent studies, the next of which investigated neurobehavioral outcomes following MIA. Our results from that study showed that motor differences occurred in juvenile offspring following MIA at E16 only, and these differences were compensated for in adolescence. Then, there was a decline in motor behavior capabilities in adulthood, again only for animals exposed to MIA on E16 (and not E12). Furthermore, our results also demonstrated adolescent and adult offspring that were exposed to MIA at E12 had diminished responses to amphetamine in reward seeking behaviors. In our final study, we aimed to investigate the molecular and cellular changes following MIA which might explain these behavioral alterations. This final study showed a differential inflammatory response in fetal midbrains depending on gestational age of exposure as well as differential developmental alterations. For example, LPS exposure at E16 resulted in decreased VM neurosphere size after 7DIV and this was associated with an increased susceptibility to neurotoxic effects of pro-inflammatory cytokines for VM neurospheres and VM DA neurons treated in culture. In utero LPS exposure at E16 also reduced DA neuron count of fetal VM, measured by TH staining. However, there were no differences in DA neuron number in juvenile, adolescent, or adult offspring. Similarly, LPS exposure did not alter cell number or morphology of glial cells in the midbrains of affected offspring. In conclusion, this thesis indicated later rat pregnancy (E16) as vulnerable time for MIA to affect the development of the nigrostriatal pathway and subsequent behavioral outcomes, possibly implicating a role for MIA in increased risk for disorders associated with motor behavior, like PD. These effects may be mediated through alterations in the placenta and altered inflammatory mediators in the offspring brain. This thesis has also shown that MIA in earlier rat pregnancy (E12) results in altered mesocorticolimbic function, and in particular MIA on E12 resulted in a differential response to amphetamine in affected offspring, which may implicate a role for MIA in increasing the risk for disorders associated with this pathway, including drug tolerance and addiction.

Reward circuitry dysfunction in psychiatric and neurodevelopmental disorders and genetic syndromes: animal models and clinical findings.

This review summarizes evidence of dysregulated reward circuitry function in a range of neurodevelopmental and psychiatric disorders and genetic syndromes. First, the contribution of identifying a core mechanistic process across disparate disorders to disease classification is discussed, followed by a review of the neurobiology of reward circuitry. We next consider preclinical animal models and clinical evidence of reward-pathway dysfunction in a range of disorders, including psychiatric disorders (i.e., substance-use disorders, affective disorders, eating disorders, and obsessive compulsive disorders), neurodevelopmental disorders (i.e., schizophrenia, attention-deficit/hyperactivity disorder, autism spectrum disorders, Tourette's syndrome, conduct disorder/oppositional defiant disorder), and genetic syndromes (i.e., Fragile X syndrome, Prader-Willi syndrome, Williams syndrome, Angelman syndrome, and Rett syndrome). We also provide brief overviews of effective psychopharmacologic agents that have an effect on the dopamine system in these disorders. This review concludes with methodological considerations for future research designed to more clearly probe reward-circuitry dysfunction, with the ultimate goal of improved intervention strategies.

Obstetric mode of delivery and child psychological development

Background/aims: Objective of the current thesis is to investigate the potential impact of birth by Caesarean section (CS) on child psychological development, including autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), behavioural difficulties and school performance. Structure/methods: Published literature to date on birth by CS, ASD and ADHD was reviewed (Chapter 2). Data from the UK Millennium Cohort Study (MCS) were analysed to determine the association between CS and ASD, ADHD and parent-reported behavioural difficulties (Chapter 3). The Swedish National Registers were used to further assess the association with ASD, ADHD and school performance (Chapters 4-6). Results: In the review, children born by CS were 23% more likely to be diagnosed with ASD after controlling for potential confounders. Only two studies reported adjusted estimates on the association between birth by CS and ADHD, results were conflicting and limited. CS was not associated with ASD, ADHD or behavioural difficulties in the UK MCS. In the Swedish National Registers, children born by CS were more likely to be diagnosed with ASD or ADHD. The association with elective CS did not persist when compared amongst siblings. There was little evidence of an association between birth by elective CS and poor school performance. Children born by elective CS had slight reduction in school performance. Conclusions: The lack of association with the elective CS in the sibling design studies indicates that the association in the population is most probably due to confounding. A small but significant association was found between birth by CS and school performance. However, the effect may have been due to residual confounding or confounding by indication and should be interpreted with caution. The overall conclusion is that birth by CS does not appear to have a causal relationship with the aspects of child psychological development investigated.

La thérapie cognitive-comportementale dans le traitement du TDAH chez l'adulte: état des connaissances

Essai doctoral présenté à la Faculté des Arts et des Sciences en vue de l'obtention du grade de doctorat en psychologie clinique (D.psy.)

Personcentrerad omvårdnad för familjer där barn har ADHD En litteraturstudie

Bakgrund: Attention deficit hyperactivity disorder (ADHD) är den vanligaste neuropsykiatriska diagnosen bland barn, prevalens ca 5%. ADHD kan skapa en myriad svårigheter som ibland är svåra att koppla till kärnsymtomen. Miljö och bemötande är viktiga faktorer. Syfte: Syftet med följande studie har varit att beskriva hur specialistsjuksköterskan i psykiatrisk vård kan anpassa den personcentrerade omvårdnaden för barn och familjer där barn har ADHD. Metod: Litteraturstudie av tolv kvalitativa artiklar. Resultat: Tre huvudteman och tre underteman identifierades, 1)Problem, svårighet och avsaknad med underteman; medicinering, psykosocialt och information. 2) Insats, stöd och behov 3) Sjuksköterskeinsats. Svårigheter kring medicinering, kränkningar och att hitta eftersökt information ses. Behovet av struktur, förstående nyckelpersoner och information i ett familjeperspektiv är stort. Sjuksköterskeinsatsen är mångfacetterad, den innefattar att fånga upp och förstå de problem och svårigheter patienten upplever, utbilda, förklara och ge saklig information i ett sociokulturellt kontext till patient och familj. Slutsats: Psykiatrisjuksköterskan måste känna till och respektera varje individs upplevelse av vad som är problemskapande. Struktur, förutsägbarhet, kunskap och en förstående omgivning är nyckelfaktorer för att skapa god personcentrerad omvårdnad för familjer där barn har ADHD.

Perfil Cognitivo e Perfil de Capacidades e Dificuldades de Crianças com Perturbações de Hiperatividade e Défice de Atenção (PHDA)

Apesar da Perturbação de Hiperatividade e Défice de Atenção (PHDA) ser uma das perturbações mais estudadas nos últimos anos, a definição da avaliação com vista ao seu diagnóstico está longe de ser consensual. Neste estudo quantitativo, transversal, foram avaliadas duas amostras de crianças com recurso à Escala de Inteligência de Wechsler para Crianças – III (WISCIII), duas amostras de pais com recurso ao Questionário de Capacidades e Dificuldades (Versão para pais) e duas amostras de professores com recurso ao Questionário de Capacidades e Dificuldades (Versão para professores). Os resultados demonstram que as crianças com PHDA apresentam um perfil cognitivo globalmente inferior ao das crianças sem diagnóstico de PHDA, mantendo no entanto, um Coeficiente Verbal (QIV) superior ao Coeficiente de Realização (QIR). Para o perfil de capacidades e de dificuldades, as crianças com esta perturbação demonstram genericamente dificuldades mais acentuadas do que as crianças sem PHDA. A multiplicidade de sintomas que caracterizam as crianças com esta perturbação, levam os investigadores a diferentes linhas de orientação. Desta forma, a definição de um perfil tipo para estas crianças poderá auxiliar na avaliação, no diagnóstico, na intervenção e na concordância entre os profissionais de saúde. / Despite Attention Deficit and Hyperactivity Disorder (ADHD) is one of the most studied disorders in the past years, the definition of the assessment for the purpose of diagnosis is far from consensual. In this quantitative and cross-finding study, two samples of children were assessed using the Wechsler Intelligence Scale for Children - III (WISC-III), two samples of parents were assessed using the Strengths and Difficulties Questionnaire (parent version) and two samples of teachers were assessed using Strengths and Difficulties Questionnaire (teacher version). The results show that children with ADHD have an overall lower cognitive profile in comparison to children without the diagnosis of ADHD, while maintaining a better Verbal Coefficient than the Performance Coefficient. In relation to the profile of strengths and difficulties, children with this disorder generally show more pronounced difficulties than children without ADHD. The multiplicity of symptoms that characterize children with this disorder, lead investigators to different guidelines. Thus, the definition of a profile type for these children may assist the assessment, the diagnosis, the intervention and the agreement among health professionals.

Tourette's syndrome and associated disorders: a systematic review

To compile data on Tourette's syndrome (TS), tics and associated disorders. METHODS: A systematic review of the literature was conducted using the 5S levels of organization of healthcare research evidence (systems, summaries, synopses, syntheses, studies), based on the model described by Haynes. The search keywords were Tourette, tics and comorbidity, which were cross-referenced. Studies provided by publishers and articles being processed on July 31, 2013, were also included. RESULTS: Of all studies retrieved during the search, 64 were selected because they analyzed the epidemiology, clinical features and etiopathogenesis of TS and its comorbidities. TS is classified as a hyperkinetic movement disorder, and at least 90% of the patients have neuropsychiatric comorbidities, of which attention deficit hyperactivity and obsessive-compulsive disorders are the most common. The syndrome is clinically heterogeneous and has been associated with a dysfunction of cortico-striatal-thalamic-cortical circuits involving various neurotransmitters. Although its genetic etiology has been widely studied, other factors may be important to understand this syndrome and its associated disorders. CONCLUSIONS: TS is a neurodevelopmental disorder that results from the impact of stress factors on a vulnerable biological substrate during the critical periods of neurodevelopment. The study of TS and its comorbidities may contribute, at different levels, to the understanding of several neuropsychiatric disorders of clinical and therapeutic relevance.

Negligent Eye

This presentation was both an illustrated lecture and a published paper presented at the IMPACT 9 Conference Printmaking in the Post-Print Age, Hangzhou China 2015. It was an extension of the exhibition catalogue essay for the Bluecoat Gallery Exhibition of the same name. In 2014 I curated an exhibition The Negligent Eye at the Bluecoat Gallery in Liverpool as the result of longstanding interest in scanning and 3D printing and the role of these in changing the field of Print within Fine Art Practice. In the aftermath of curatingshow I have continued to reflect on this material with reference to the writings of Vilém Flusser and Hito Steyerl. The work in the exhibition came from a wide range of artists of all generations most of whom are not explicitly located within Printmaking. Whilst some work did not use any scanning technology at all, a shared fascination with the particular translating device of the systematizing ‘eye’ of a scanning digital video camera, flatbed or medical scanner was expressed by all the work in the show. Through writing this paper I aim to extend my own understanding of questions, which arose from the juxtapositions of work and the production of the accompanying catalogue. The show developed in dialogue with curators Bryan Biggs and Sarah-Jane Parsons of the Bluecoat Gallery who sent a series of questions about scanning to participating artists. In reflecting upon their answers I will extend the discussions begun in the process of this research. A kind of created attention deficit disorder seems to operate on us all today to make and distribute images and information at speed. What value do ways of making which require slow looking or intensive material explorations have in this accelerated system? What model of the world is being constructed by the drive to simulated realities toward ever-greater resolution, so called high definition? How are our perceptions of reality being altered by the world-view presented in the smooth colourful ever morphing simulations that surround us? The limitations of digital technology are often a starting point for artists to reflect on our relationship to real-world fragility. I will be looking at practices where tactility or dimensionality in a form of hard copy engages with these questions using examples from the exhibition. Artists included in the show were: Cory Arcangel, Christiane Baumgartner, Thomas Bewick, Jyll Bradley, Maurice Carlin, Helen Chadwick, Susan Collins, Conroy/Sanderson, Nicky Coutts, Elizabeth Gossling, Beatrice Haines, Juneau Projects, Laura Maloney, Bob Matthews, London Fieldworks (with the participation of Gustav Metzger), Marilène Oliver, Flora Parrott, South Atlantic Souvenirs, Imogen Stidworthy, Jo Stockham, Wolfgang Tillmans, Alessa Tinne, Michael Wegerer, Rachel Whiteread, Jane and Louise Wilson. Scanning, Art, Technology, Copy, Materiality.

How do Young People with ADHD Perceive their Condition: An Interpretative Phenomenological Analysis

Attention Deficit Hyperactivity Disorder (ADHD) is one the most prevalent of childhood diagnoses. There is limited research available from the perspective of the child or young person with ADHD. The current research explored how young people perceive ADHD. A secondary aim of the study was to explore to what extent they identify with ADHD. Five participants took part in this study. Their views were explored using semi-structured interviews guided by methods from Personal Construct Psychology. The data was analysed using Interpretative Phenomenological Analysis (IPA). Data analysis suggests that the young people’s views of ADHD are complex and, at times, contradictory. Four super-ordinate themes were identified: What is ADHD?, The role and impact of others on the experience of ADHD, Identity conflict and My relationship with ADHD. The young people’s contradictory views on ADHD are reflective of portrayals of ADHD in the media. A power imbalance was also identified where the young people perceive that they play a passive role in the management of their treatment. Finally, the young people’s accounts revealed a variety of approaches taken to make sense of their condition.

A violência escolar e a sua relação com diferentes psicopatologias

Desde há alguns anos a esta parte, muito se tem discutido a temática do Bullying nas atuais sociedades modernas e industrializadas. Com o avanço da técnica e do conhecimento científico, só recentemente se lhe dá a devida atenção, dado os danos que pode causar a médio e longo prazo em todos os intervenientes nesse fenómeno de exteriorização da violência. Embora se tenham desenhado múltiplas estratégias para a sua explicação e combate, continua a ser um tema muito atual, pois embora pesem os modelos de intervenção de certa forma já padronizados, há sempre a necessidade de os adaptar ao contexto de cada caso. Desta forma este tema continua e continuará a ser alvo de estudo e aprofundamento. Neste trabalho, analisaremos toda a temática do Bullying, desde a sua conceptualização, passando pela sua etiologia, fatores de risco, intervenientes, bem como o seu diagnóstico, combate e prevenção. Partindo da premissa de que este tema envolve uma série de variáveis que vão para além dos problemas comportamentais e/ou da indisciplina, tais como variáveis culturais, sociofamiliares, escolares, pessoais/psicológicas e psicopatológicas, é nesta ultima variável que iremos focar mais especificamente o nosso trabalho, nomeadamente no estabelecimento de uma correlação entre o Bullying e a Perturbação de Défice de Atenção e Hiperatividade. Nos alunos mais jovens, o défice de atenção com hiperatividade, a depressão bem como a ansiedade, são problemas paralelos ao Bullying. Dado o facto de as crianças com estas caraterísticas serem mais vulneráveis à violência, pois têm dificuldades de integração no seio escolar e/ou no grupo de pares, podemos afirmar desde já e com bastante veemência que estas pertencem a um grupo com um enorme fator de risco para se envolver em comportamentos relacionados com o Bulliyng em toda a sua abrangência.