A total population of 4,479 children (7-15 years of age) attended school in Ludvika & Smedjebacken in 2000. All the school children and their parents were asked to fill in a questionnaire concerning different tics A three-stage procedure was used: tic identification, interview, and clinical assessment. Tourette syndrome, according to DSM IV criteria was found in 25 (0.6%) of the children, another 34 (0.8%) suffered from chronic motor tics (CMT), 24 (0.4%) from chronic vocal tics (CVT) and 214 (4.8%) children had had transient tics (TT) during the last year. Altogether 297 (6.6%) children had or had had some tic disorder. Twenty-five controls without tics and 25 children with TT of the same age, sex and school as the TS children were randomly chosen. They were together with the 34 children with CMT and the 24 children with CVT examined with use of a broad battery of instruments. The mean age of the first symptoms of TS was significantly lower than the onset of chronic motor/vocal tics. A younger age of onset of TS indicated more severe tics. Eighty per cent had a first-degree relative with a psychiatric disorder such as tic disorder, obsessive-compulsive behaviour, attentiondeficit/hyperactivity disorder (ADHD), or depression. A non-significant increase with regard to reduced optimality score in the pre-, peri-, or neonatal periods was found in children with TS compared to controls. No differences were found concerning socio-economic status. Psychiatric comorbid disorders were found in 92% of the children with TS. ADHD was most common. Patterns of psychiatric comorbidity were similar in children with TS and CVT. Children with TS perform poorer than the population in general with respect to cognitive functioning and self-perception. The results are discussed as they relate to the need for case identification, diagnosis, intervention, and treatment.

<p>Among some researchers, there is an emerging conceptualization of chronic tic disorders (CTDs) as conditions that are partially rooted in avoidance of tic-related private experiences (i.e., painful or difficult thoughts and feelings) and internal sensations (i.e., premonitory urges to tic). The first specific aim of the present research was to investigate the possibility that experiential avoidance is related to tic severity and perceived quality of life in individuals with CTDs. The second aim was to determine whether the efficacy of Habit Reversal Training (HRT), the most prevalent and effective behavioral intervention for CTDs to date, might be enhanced by combining it with Acceptance and Commitment Therapy (ACT), an intervention that directly targets experiential avoidance. These aims were addressed by conducting two related studies. Study I, an online survey, included 239 adults (<italic>M</italic> = 37.6 years; <italic>SD</italic> = 13.8 years) who reported having been previously diagnosed with a CTD. Results showed that levels of premonitory urges, as well as both general and tic-specific experiential avoidance, were significantly positively related to tic severity. General and tic-specific experiential avoidance were also significantly negatively related to perceived quality of life. Psychometric analyses of two novel measures developed for Study I (i.e., the Yale Global Tic Severity Scale-Self-Report Version and the Acceptance and Action Questionnaire-Tic-Specific Version) demonstrated excellent internal consistency and convergent validity. Study II, a multi-site pilot investigation, involved 13 adolescents (<italic>M</italic> = 15.4 years; <italic>SD</italic> = 1.3 years) who were treated with either HRT alone or a novel HRT+ACT intervention. Results suggest that the HRT+ACT treatment is feasible, highly acceptable to both patients and parents, and as effective as HRT alone at reducing tic severity from pre-treatment through week 22 follow-up. Participants in both groups reported clinically significant post-treatment decreases in general and tic-specific experiential avoidance and improvements in overall functioning. Researchers concluded that experiential avoidance plays an important role in tic expression and overall functioning for individuals with CTDs. Results support additional development and testing of the promising HRT+ACT intervention, to evaluate its efficacy alone and in comparison to other relevant psychosocial and pharmacological interventions.</p> / Dissertation

Increasing numbers of children being referred for mental health services are exhibiting problematic behaviors that can be subsumed under the category of Disruptive Behavior Disorders. This study with its foundations in a post-positivist approach was designed to explore treatment effectiveness of cognitive behavioral intervention applied to adolescents at Oak Grove Institute, a residential treatment facility. This study hypothesized that Wexler's PRISM Model, with its integration of affect, would be instrumental in modifying disruptive behavior as measured at Oak Grove Institute. Although the small sample size precluded statistically significant findings, there were interesting results with respect to two dependant variables. Findings approached significance on measures of impulsivity and verbal aggression. That is, impulsivity and verbal aggression scores were lowered.

Gilles de la Tourette syndrome (GTS) is a neuropsychiatric disorder. Because motor signs are the defining feature of GTS, addressing the neurophysiology of motor processes is central to understanding GTS. The integration of voluntary motor processes is subject to so-called “binding problems”, i.e., how different aspects of an action are integrated. This was conceptualized in the theory of event coding, in which ‘action files’ accomplish the integration of motor features. We examined the functional neuroanatomical architecture of EEG theta band activity related to action file processing in GTS patients and healthy controls. Whereas, in keeping with previous data, behavioral performance during action file processing did not differ between GTS and controls, underlying patterns of neural activity were profoundly different. Superior parietal regions (BA7) were predominantly engaged in healthy controls, but superior frontal regions (BA9, BA10) in GTS indicated that the processing of different motor feature codes was central for action file processing in healthy controls, whereas episodic processing was more relevant in GTS. The data suggests a cascade of cognitive branching in fronto-polar areas followed by episodic processing in superior frontal regions in GTS. Patients with GTS accomplish the integration of motor plans via qualitatively different neurophysiological processes.

It has been suggested that psychosocial stress influences situational fluctuations of tic frequency. However, evidence from experimental studies is lacking. The current study investigated the effects of the Trier Social Stress Test (TSST-C) on tic frequency in 31 children and adolescents with tic disorders. A relaxation and a concentration situation served as control conditions. Patients were asked either to suppress their tics or to “tic freely.” Physiological measures of stress were measured throughout the experiment. The TSST-C elicited a clear stress response with elevated levels of saliva cortisol, increased heart rate, and a larger number of skin conductance responses. During relaxation and concentration, the instruction to suppress tics reduced the number of tics, whereas during stress, the number of tics was low, regardless of the given instruction. Our study suggests that the stress might result in a situational decrease of tic frequency.

Transtornos psiquiátricos têm sido descritos com maior freqüência em pacientes com Coréia de Sydenham (CS) do que em pacientes com Febre Reumática(FR) sem CS. Os objetivos desse estudo forma o de verificar: se existe uma freqüência aumentada de transtornos psiquiátricos em pacientes com FR comparados a um grupo controle; se estes transtornos psiquiátricos apresentam freqüência aumentada em grupo de pacientes com Coréia de Sydenham, a manifestação da FR no Sistema Nervoso Central, comparado ao grupo de pacientes com FR sem CS; e, por fim, verificar a relação temporal entre o início destes diversos transtornos e o início da FR. Concluiu-se que a presença de FR está associada a uma maior freqüência de transtornos psiquiátricos, mesmo na ausência de CS. O TDHA e o TT, neste estudo, foram indicados como fatores de risco para o desenvolvimento de CS em pacientes com FR. / Psychiatric disorders have been described as more frequent in Sydenham’s Chorea patients SC) than in rheumatic fever without SC (RF). The aim of this study was to investigate it the prevalence of psychiatric disorders in RF is associated with the occurrence of SC. Furthermore, age of onset of the various symptoms was determined in order to clarify the temporal relationship between the presence of psychiatric symptoms and either rheumatic fever or Sydenham’s Chorea. Using semi-structured diagnostic interviews for DSM-IV and ratings scales, the authors assessed 22 SC patients, 20 RF patients and 20 pediatric controls. Statistical Analyses were performed using Pearson chi-square (Fischer’s exact test for 2x2 tables) for comparisons of categorial variables. Comparisons of continuous variables among groups were carried out using ANOVA and the Student t-test, when only groups were analyzed. In order to establish the risk for the development of SC and OCD given to presence of other co-morbid conditions, a logistic regression was applied. The level of significance adopted was 0.05. Both the SC and RF groups showed a greater prevalence of psychiatric disorders. The SC sample showed higher frequency of major depression disorder (MDD) (x2 = 19,1, df = 2, p = 0,00007), tic disorder (TD) (x2 = 21,1, df = 2, p = 0,00001) and attention-deficit hyperactivity disorder (ADHD) (x2-21,7, df = 2, p = 0,0002). Although Obsessive-Compulsive Disorder (OCD) was not statiscally higher in the SC and RF groups, Obsessive-Compulsive Symptoms were more frequent in both RF and SC groups compared to the controls (x2 = 7,3, df = 2, p = 0,025). The age of onset for both ADHD and TD predicted the risk for development of SC. The risk of development of OCD in SC children was also associated with the age of onset of ADHD. RF seems to confer increased risk to develop neuropsychiatric disorders even in patients without SC. In this sample, ADHD and TD was an important risk factor for the occurrence of co-morbid illnesses.

Transtornos psiquiátricos têm sido descritos com maior freqüência em pacientes com Coréia de Sydenham (CS) do que em pacientes com Febre Reumática(FR) sem CS. Os objetivos desse estudo forma o de verificar: se existe uma freqüência aumentada de transtornos psiquiátricos em pacientes com FR comparados a um grupo controle; se estes transtornos psiquiátricos apresentam freqüência aumentada em grupo de pacientes com Coréia de Sydenham, a manifestação da FR no Sistema Nervoso Central, comparado ao grupo de pacientes com FR sem CS; e, por fim, verificar a relação temporal entre o início destes diversos transtornos e o início da FR. Concluiu-se que a presença de FR está associada a uma maior freqüência de transtornos psiquiátricos, mesmo na ausência de CS. O TDHA e o TT, neste estudo, foram indicados como fatores de risco para o desenvolvimento de CS em pacientes com FR. / Psychiatric disorders have been described as more frequent in Sydenham’s Chorea patients SC) than in rheumatic fever without SC (RF). The aim of this study was to investigate it the prevalence of psychiatric disorders in RF is associated with the occurrence of SC. Furthermore, age of onset of the various symptoms was determined in order to clarify the temporal relationship between the presence of psychiatric symptoms and either rheumatic fever or Sydenham’s Chorea. Using semi-structured diagnostic interviews for DSM-IV and ratings scales, the authors assessed 22 SC patients, 20 RF patients and 20 pediatric controls. Statistical Analyses were performed using Pearson chi-square (Fischer’s exact test for 2x2 tables) for comparisons of categorial variables. Comparisons of continuous variables among groups were carried out using ANOVA and the Student t-test, when only groups were analyzed. In order to establish the risk for the development of SC and OCD given to presence of other co-morbid conditions, a logistic regression was applied. The level of significance adopted was 0.05. Both the SC and RF groups showed a greater prevalence of psychiatric disorders. The SC sample showed higher frequency of major depression disorder (MDD) (x2 = 19,1, df = 2, p = 0,00007), tic disorder (TD) (x2 = 21,1, df = 2, p = 0,00001) and attention-deficit hyperactivity disorder (ADHD) (x2-21,7, df = 2, p = 0,0002). Although Obsessive-Compulsive Disorder (OCD) was not statiscally higher in the SC and RF groups, Obsessive-Compulsive Symptoms were more frequent in both RF and SC groups compared to the controls (x2 = 7,3, df = 2, p = 0,025). The age of onset for both ADHD and TD predicted the risk for development of SC. The risk of development of OCD in SC children was also associated with the age of onset of ADHD. RF seems to confer increased risk to develop neuropsychiatric disorders even in patients without SC. In this sample, ADHD and TD was an important risk factor for the occurrence of co-morbid illnesses.

It has been suggested that psychosocial stress influences situational fluctuations of tic frequency. However, evidence from experimental studies is lacking. The current study investigated the effects of the Trier Social Stress Test (TSST-C) on tic frequency in 31 children and adolescents with tic disorders. A relaxation and a concentration situation served as control conditions. Patients were asked either to suppress their tics or to “tic freely.” Physiological measures of stress were measured throughout the experiment. The TSST-C elicited a clear stress response with elevated levels of saliva cortisol, increased heart rate, and a larger number of skin conductance responses. During relaxation and concentration, the instruction to suppress tics reduced the number of tics, whereas during stress, the number of tics was low, regardless of the given instruction. Our study suggests that the stress might result in a situational decrease of tic frequency.

Le terme « tiqueur » est utilisé pour alléger le texte, et ce, sans préjudice. / Les tics sont des manifestations motrices ou phoniques, involontaires, soudaines, rapides, stéréotypées, non rythmiques et répétitives (Bloch & Leckman, 2009). Selon la cinquième version du manuel diagnostique et statistique des troubles mentaux (DSM-5), le Syndrome Gilles de la Tourette (SGT) inclut la présence de tics moteurs multiples associés à au moins un tic phonique se manifestant plusieurs fois par jour, depuis plus d'un an (APA, 2013). Lorsqu’au moins un tic moteur ou phonique existe de façon isolée depuis au moins un an, le diagnostic de Trouble de tics chroniques est plutôt envisagé (TTC). Plusieurs études ont permis de montrer une similarité entre le SGT et le TTC du point de vue des comorbidités, ainsi que des variables neuropsychologiques et psychosociales associées (Spencer & al., 1995; Shapiro & Shapiro, 1982). Ainsi, plusieurs auteurs suggèrent que le TTC constitue une forme moins sévère du SGT (Jedynak, 2004). Les effets néfastes associés aux tics chroniques sur la vie sociale, scolaire ou professionnelle sont suffisamment bien documentés dans la littérature scientifique (Cavanna, Servo, Monaco & Robertson, 2009; Robertson, 2006; Thibert, Day & Sandor, 1995). Les thérapies cognitivo-comportementales (TCC) représentent une bonne alternative à la médication dont les effets secondaires peuvent parfois être très incommodants. Toutefois, ces dernières montrent un taux d’efficacité très variable, de 30 % à 67 % selon les études (Verdellen, Van de Griendt, Hartmann & Murphy, 2011; Piacentini & al., 2010; O’Connor et al., 2015, 2008, 2005a, 2005b, 2001, 1997a, 1997b, 1997c). Pour cette raison, plusieurs auteurs ont tenté de prédire le taux de réussite thérapeutique associé à une TCC par une série de facteurs neuropsychologiques afin de trouver un élément d’explication à ces variations. La plupart s’accordent pour dire que le taux de réussite d’une TCC dépend du fonctionnement exécutif, et notamment des capacités d’inhibition et de flexibilité cognitive. Les participants ciblés par cette étude sont des adultes âgés entre 18 et 50 ans souffrants d’un SGT ou d’un Trouble de tics chroniques (n = 92), comparés à des participants sans problème psychiatrique ou neurologique (n = 56). La cueillette de données s’est effectuée au Centre d’Étude sur les Troubles Obsessionnel-Compulsif et les Tics (CÉTOCT), entre 2003 et 2013. L’objectif du premier volet de cette étude visait à comparer les capacités d’inhibition et de flexibilité cognitive chez un groupe de participants atteints de tics chroniques et un groupe de participants neurotypiques (groupe témoin). D’autre part, l’objectif du deuxième volet visait à mesurer les capacités d’inhibition et de flexibilité cognitive chez deux sous-groupes de participants : un sous-groupe ayant fortement réussi une Thérapie Cognitivo-Comportementale (TCC) pour les tics chroniques et un autre ayant faiblement réussi. Les résultats obtenus montrent que les participants atteints de tics chroniques présentent, de façon significative, de plus faibles capacités d’inhibition et de flexibilité cognitive qu’un groupe témoin. Toutefois, seules les capacités de flexibilité cognitive permettent de prédire significativement le taux de réussite thérapeutique associé à une TCC pour les tics chroniques. / Tics are involuntary motor movements or vocalizations which are sudden, rapid, stereotyped, non-rhythmic and repetitive (Bloch & Leckman, 2009). According to the fifth edition of the Diagnostic and statistical manual of mental disorders (DSM-5), Tourette’s Disorder (TD) includes multiple motor tics and at least one vocal tic that can be observed multiple times every day for more than a year (APA, 2013). When at least one motor or vocal tic can be observed for at least a year, Chronic Tic Disorder (CTD) is diagnosed instead. Multiple studies show similarities between TD and CTD for comorbidities as well as associated neuropsychological and psychosocial variables (Spencer & al., 1995; Shapiro & Shapiro, 1982). Many authors suggest that CTD is actually a milder form of TD (Jedynak, 2004). The harmful effects of chronic tics on social, academic or professional life are extensively documented in the scientific literature (Cavanna, Servo, Monaco & Robertson, 2009; Robertson, 2006; Thibert, Day & Sandor, 1995). Cognitive-behavioral therapies (CBT) represent an alternative to medications whose side effects can sometimes be incapacitating. However, their success rate is highly variable, from 30% to 67% depending on the study (Verdellen, Van de Griendt, Hartmann & Murphy, 2011; Piacentini & al., 2010; O’Connor et al., 2015, 2008, 2005a, 2005b, 2001, 1997a, 1997b, 1997c). For this reason, many authors tried to predict the therapeutic success rate by using a series of neuropsychological factors in order to explain these variations. The general consensus is that the success rate of a CBT depends on executive functioning, notably on inhibition and cognitive flexibility. Participants in this study are adults aged 18 to 50 suffering from TD or CTD (n = 92) who are compared to participants without a diagnosed psychiatric or neurological disorder (n = 56). The data was collected at the Centre d’Étude sur les Troubles Obsessionnels-Compulsifs et les Tics (CÉTOCT) between 2003 and 2013. The objective of the first part of this study was to compare the inhibition and cognitive flexibility of a group of participants with chronic tics and a group of neurotypical participants (control group). On the other hand, the aim of the second component was to measure inhibition and cognitive flexibility in two subgroups of participants : a subgroup that strongly succeeded in Cognitive Behavioral Therapy (CBT) for chronic tics and another with weak success. The results showed that participants with chronic tics had significantly lower inhibition and cognitive flexibility than a control group. However, only cognitive flexibility can significantly predict the therapeutic success rate associated with CBT for chronic tics.

Il est reconnu que le développement social des enfants et des adolescents est soutenu par l’évolution des capacités cognitives et sociocognitives en interaction avec les expériences relationnelles quotidiennes. Ce développement offrirait une compréhension de plus en plus vaste du monde social et culturel, permettant aux individus de s’intégrer à la société en tant que citoyen autonome et responsable au début de l’âge adulte. Malgré la validité de ce portrait global, il reste beaucoup à comprendre sur l’influence entre les capacités cognitives (ex. : fonctions exécutives) et sociocognitives (ex. : raisonnement moral (RM), théorie de l’esprit (TdE), reconnaissance des émotions) durant le développement, ainsi que sur leur impact individuel et additif sur le comportement social. Encore moins d’informations existent sur ces interactions dans le cadre du développement atypique, comme celui des jeunes présentant des troubles neurodéveloppementaux. L’objectif général de cette thèse est donc d’explorer les interrelations entre les différentes composantes du fonctionnement exécutif (FE) et de la cognition sociale chez les jeunes et leur contribution à l’adaptation sociale. Le but des travaux est aussi d’observer les effets potentiels d’un développement déficitaire de ces fonctions dans le contexte d’un trouble neurodéveloppemental, le Syndrome de Gilles de la Tourette (SGT). Cette thèse est composée de trois articles empiriques concernant trois études qui abordent ces objectifs généraux. Les deux premières études explorent le FE, la cognition sociale et les tendances d’interaction sociale chez des enfants neurotypiques de 6 à 12 ans. La première étude, centrée sur les interrelations entre les capacités cognitives et sociocognitives, montre que la maturité du RM est associée positivement au FE, à la reconnaissance des émotions et à la TdE. Le FE et la cognition sociale contribueraient de manière significative à la maturité du RM et joueraient un rôle médiateur dans la relation entre l’âge et le RM. La deuxième étude, plus centrée sur les tendances comportementales dans la vie quotidienne, montre que le FE quotidien joue un rôle médiateur qui expliquerait partiellement le lien entre l’empathie et les tendances prosociales des enfants et complètement le lien avec leurs tendances agressives. La troisième étude montre pour la première fois l’existence d’un fonctionnement plus pauvre de la TdE chez les jeunes ayant le SGT. Ces jeunes présentent également un moins bon FE quotidien et plus de difficultés et comportementales, notamment au niveau des aspects sociaux. Cette étude révèle des liens entre le RM des jeunes atteints du SGT et leur flexibilité cognitive, fluence verbale et FE quotidien, de même qu’avec la sévérité de leurs tics et leurs difficultés sociales. Les difficultés de comportement sont expliquées en grande partie par la sévérité des tics, le FE et la cognition sociale. Ensemble, les données des études présentées dans cette thèse contribuent à établir un portrait plus détaillé des relations réciproques entre le FE, la cognition sociale et l’adaptation sociale, lors du développement typique et atypique. Les résultats offrent de nouvelles pistes pour la compréhension clinique des difficultés d’adaptation sociale précoce et suggère un fondement empirique pour l’élaboration de programmes d’intervention sur les compétences sociales. / It is recognized that the social development of children and youth is supported by improvements in their cognitive and social cognitive abilities, which are driven by everyday interpersonal experiences. This development provides a broader understanding of the social and cultural world, allowing individuals to become integrated members of society and autonomous and responsible citizens in early adulthood. Despite the validity of this overall picture, there is still much to be learned about the mutual influence between cognitive (e.g.,executive functions) and socio-cognitive abilities (e.g., theory of mind, moral reasoning, emotion recognition) during development, as well as their individual and additive impact on social behavior. Even less is known about these interactions in the context of atypical development, such as in youth with neurodevelopmental disorders. The main objective of this thesis is to explore the reciprocal associations between different components of executive functioning (EF) and social cognition in youth and their contribution to social adaptation. We also aimed to observe the potential effects of impaired development of these functions in a neurodevelopmental disorder, Tourette’s Syndrome (TS). This thesis is composed of three empirical articles pertaining to three studies that address these main objectives. The first two studies explore EF, social cognition and social interaction patterns among neurotypical children aged 6 to 12 years. The first study focuses on the interrelations between cognitive and social cognitive abilities, showing that moral reasoning (MR) maturity is positively associated with EF, emotion recognition and theory of mind. EF and social cognition contribute significantly to the MR maturity and play a mediating role in the relationship between age and MR. The second study, which focuses more on behavioral patterns in everyday life, shows that everyday EF plays a mediating role that partly explains the link between empathy and prosocial tendencies in children and completely explains the link with their aggressive tendencies. The third study shows for the first time that theory of mind skills are poorer among youth with TS, and they have reduced everyday EF and more emotional and behavioral difficulties, particularly in the social domain. This study also reveals links between the MR skills of youth with TS and their cognitive flexibility, verbal fluency, everyday EF, tic severity and social difficulties. Social difficulties in this group are largely explained by tic severity, EFand social cognition. Overall, the results of the studies presented in this thesis contribute to building a more comprehensive picture of the interrelationship between EF, social cognition and social adaptation during typical and atypical development. The findings offer new avenues for improving our clinical understanding of early social adjustment difficulties and provide an empirical basis for the development of social skills intervention programs.