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Executive function in children with Tourette Syndrome and/or Attention Deficit Hyperactivity Disorder
- Emily L. Harris, Linda J. Schuerholz, Harvey S. Singer, Mark J. Reader, Janice E. Brown, Christiane Cox, Jennifer Mohr, Gary A. Chase, Martha B. Denckla
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- Journal:
- Journal of the International Neuropsychological Society / Volume 1 / Issue 6 / November 1995
- Published online by Cambridge University Press:
- 26 February 2009, pp. 511-516
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- Article
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Tourette Syndrome (TS) in children is associated with various neurobehavioral disorders including attention deficit hyperactivity disorder (ADHD). Children with TS and ADHD show some difficulties with neuropsychological tasks, but we do not know if children with TS alone have neuropsychological deficits. To assess specific cognitive differences among children with TS and/or ADHD, we administered a battery of neuropsychological tests, including 10 tasks related to executive function (EF), to 10 children with TS-only, 48 with ADHD-only, and 32 with TS+ADHD. Children in all groups could not efficiently produce output on a timed continuous performance task [Test of Variables of Attention (TOVA) mean reaction time and reaction time variability]. Children with TS-only appeared to have fewer EF impairments and significantly higher perceptual organization scores than children with TS+ADHD or ADHD-only. These findings suggest that deficiencies in choice reaction time and consistency of timed responses are common to all three groups, but children with TS-only have relatively less EF impairment than children with TS+ADHD or ADHD-only. (JINS, 1995, 1, 511–516.)
38 - Tourette syndrome
- from PART III - DISORDERS OF MOTOR CONTROL
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- By Donna J. Stephenson, Department of Neurology, Johns Hopkins University, Baltimore, Maryland, USA, Harvey S. Singer, Department of Neurology, Johns Hopkins University, Baltimore, Maryland, USA
- Edited by Arthur K. Asbury, University of Pennsylvania School of Medicine, Guy M. McKhann, The Johns Hopkins University School of Medicine, W. Ian McDonald, University College London, Peter J. Goadsby, University College London, Justin C. McArthur, The Johns Hopkins University School of Medicine
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- Book:
- Diseases of the Nervous System
- Published online:
- 05 August 2016
- Print publication:
- 11 November 2002, pp 551-567
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Summary
In 1885 George Gilles de la Tourette, a Parisian neuropsychiatrist, described nine patients with a chronic disorder characterized by the presence of multiple motor and vocal tics. He recognized many of the salient clinical features of the syndrome that today bears his name, including its onset in childhood, the tendency of tics to wax and wane, and the presence of a variety of comorbid neurobehavioural problems such as obsessive–compulsive symptoms, anxieties, and phobias. Nevertheless, Gilles de la Tourette (1885) and his mentor Charcot attributed this disorder to a form of ‘hereditary insanity’ and felt it was a degenerative disorder with ‘no hope of a complete cure’. Today, Tourette syndrome (TS) is considered a complex neuropsychiatric disorder with a wide spectrum of behavioural manifestations and psychological comorbidities.
Clinical features
Tics are the cardinal feature of TS. They encompass a wide variety of involuntary movements and sounds and are formally defined as involuntary, sudden, rapid, brief, repetitive, non-rhythmic stereotyped movements or vocalizations. Motor tics consist of involuntary movements and are subdivided into simple and complex subtypes. Simple motor tics are movements of single muscle groups. Examples include eye blinking, head jerking, and facial twitching. Complex motor tics consist of a coordinated pattern of movements that may be non-purposeful (facial or body contortions) or appear to be more purposeful but actually serve no purpose (touching, smelling, jumping, obscene gestures). Copropraxia describes the presence of obscene gestures, whereas echopraxia is the imitation of the gestures of others as a tic manifestation. Phonic (vocal) tics involve the production of sound. Simple phonic tics include sniffing, grunting, and throat clearing. Complex phonic tics involve the production of partial or complete words, phrases, or sentences. Palilalia is the repetition of one's own words and echolalia is the repetition of words of another person. Coprolalia is a dramatic type of tic that consists of the involuntary utterance of obscene words and phrases. Although once considered necessary for the diagnosis of TS, coprolalia occurs in only a small minority of patients with TS (Goldenberg et al., 1994). Tics are commonly misdiagnosed as other problems such as chronic respiratory symptoms, visual problems, asthma, allergies and anxiety.
Executive function in fluency and recall measures among children with Tourette syndrome or ADHD
- E. MARK MAHONE, CHRISTINE W. KOTH, LAURIE CUTTING, HARVEY S. SINGER, MARTHA B. DENCKLA
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- Journal:
- Journal of the International Neuropsychological Society / Volume 7 / Issue 1 / January 2001
- Published online by Cambridge University Press:
- 09 February 2001, pp. 102-111
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This study assessed two relevant aspects of executive dysfunction in children with either Tourette syndrome (TS) or ADHD. Process variables derived from existing neuropsychological measures were used to clarify the executive function construct. Clustering of responses on measures of verbal fluency, figural fluency, and verbal learning was examined to assess strategic response organization. Rule breaks, intrusions, and repetition errors were recorded to assess inhibition errors. No significant differences were found among the three groups (TS, ADHD, and controls) on tasks of response organization (clustering). In our sample, both the ADHD and the TS groups were largely free from executive function impairment, and their performance on the fluency and list learning tasks was in the average range. There was a significant group difference on one of the disinhibition variables, with both TS and ADHD groups showing significantly more intrusions on verbal list learning trials than controls. When more traditional total score variables were analyzed among the three groups, there were no significant differences; however, analysis of effect size revealed medium-to-large effect sizes for Letter Word Fluency total score differences (ADHD vs. controls), and for Semantic Word Fluency total score differences (ADHD vs. TS), with the ADHD group having weaker performance in both comparisons. Results provide some support for the use and analysis of process variables—particularly those related to inhibition and intrusion errors, in addition to the total score variables when assessing executive function deficits in children with ADHD and TS. While group differences may be found, children with uncomplicated TS should not routinely be considered to have significant executive function impairments, and when deficits are found, they may be attributable to other comorbid disorders. (JINS, 2001, 7, 102–111.)