Attention woes in kids with Tourette syndrome likely caused by co-occurring ADHD

Co-occurring attention deficit hyperactivity disorder (ADHD) may be at the root of attention problems in children with Tourette syndrome (TS), according to NIMH-funded researchers. Their findings also support the theory that children with TS develop different patterns of brain activity in order to function at the same level as children without TS. The study was published in the November 2010 issue of the Journal of the American Academy of Child & Adolescent Psychiatry. LCSW Continuing Education
Background
Tourette syndrome is a chronic neurological disorder associated with repetitive, involuntary movements and vocalizations called tics. Many with TS also experience neurobehavioral problems such as inattention, hyperactivity, and impulsivity—symptoms that overlap with ADHD. In fact, researchers estimate that between 50-90 percent of youth with TS also have ADHD.

To explore the role of co-occurring ADHD in TS, Denis Sukhodolsky, Ph.D., of the Yale Child Study Center, and colleagues studied 236 children, of which:

56 had TS only
64 had ADHD only
45 had TS+ADHD
71 had neither and served as a comparison group.
The researchers used well-known, standardized measures to evaluate the children's performance on tasks requiring:

Sustained attention and inhibitory control—Participants were shown various letters on a computer screen and told to press a button when they saw certain letters but not press the button when they saw a non-target letter.
Cognitive inhibition—Participants were shown an array of dots on sheets of paper and asked to name their color (red, green, blue) as quickly as possible. In related tasks, participants were shown pages with similarly arrayed words ("red," "green," "blue") printed in black ink or a mismatched color of ink (such as "red" printed in green ink) and asked to read the words as quickly as possible.
Fine motor control—Participants placed small pegs in a specially designed pegboard in 30-second trials using only their dominant hand, only their non-dominant hand, and both hands at the same time.
Visual-motor integration—Participants copied 24 geometric designs, presented in order of increasing difficulty.
Results of the Study
Children with TS+ADHD showed similar problems with sustained attention as children with ADHD only. However, unlike those with ADHD only, children with TS+ADHD performed at the same level as the comparison group on all other tasks.

Children with TS only performed at the same level as the comparison group in tasks involving response inhibition and visual-motor integration. They performed at a slightly lower level than comparison children on the fine motor control task. Girls with TS only scored higher than boys with TS only on fine motor control tasks using their dominant hands.

Significance
The study helps to identify brain functions specific to particular disorders and the mechanisms underlying these functions.

Similarities in performance between children with TS+ADHD and those with ADHD only suggest that co-occurring ADHD may underlie attention problems in children who have TS, according to the researchers.

The researchers also noted that the children with TS only didn't show impairment in response inhibition, lending support to a theory that such children develop compensatory brain mechanisms in an effort to control involuntary tics. Past imaging studies have shown that, during tasks involving response inhibition, children with TS have greater than normal activity in brain areas associated with cognitive control.

Differences in fine motor skills between girls and boys with TS may indicate differing developmental pathways and patterns of brain growth between the sexes. Because problems with fine motor control in childhood are associated with more severe tics in adulthood, the researchers highlighted this finding as an area for further study.

What's Next
Future studies may help advance the understanding of how TS arises and changes in brain growth and functioning that are associated with the disorder.

Reference
Sukhodolsky DG, Landeros-Weisenberger A, Scahill L, Leckman JF, Schultz RT. Neuropsychological functioning in children with Tourette syndrome with and without attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry. 2010 Nov;49(11):1155-64.

Preface from...A Frontier Army Christmas

General Crook's Headquarters, Fort Fetterman (Harper's Weekly, December 17, 1876)

A number of significant military events have occurred during the Christmas season. George Washington's crossing of the Delaware River on the night of December 25, 1776, to attack unsuspecting Germans partaking in a little too much Christmas cheer became one of the most legendary events in history. Less known than Washington's holiday feat, the annual Christmas celebration at West Point in 1826 deteriorated into a mutinous "eggnog riot" involving more than a third of the corps of cadets. Following a decree that the holiday should be observed without alcohol, high-spirited Southern cadets (in particular) smuggled whiskey into the academy barracks and holiday festivities deteriorated into violence, including attempted murder. Cadet Jefferson Davis led the riot, while Cadet Robert E. Lee managed to remain aloof.

The Mexican War saw the sharp Christmas-day Battle of Bracito, which left sixty-three Mexicans dead. The victorious American troops, who suffered no deaths, celebrated Christmas night by throughly enjoying captured Mexican food, wine, and cigarillos. A generation later in 1864 General William Tecumseh Sherman sent a "Christmas card" in the form of a telegram to President Lincoln presenting the city of Savannah as a Christmas gift. The frontier army itself carried out several campaigns around the Christmas season, and the reality of bloodshed provided stark contrast to the usual joyous festivities. A dramatic example was the Indian survivors of the Wounded Knee Massacre, who were taken to a makeshift chapel hospital still decorated with Christmas finery.

As the army moved to foreign soil in more recent times, so did Christmastime conflicts. American-held Bastogne withstood a Christmas-day attack by the Germans in 1944. The Vietnam War had dragged on throughout many Christmases before President Nixon ordered the "Christmas bombing" of Hanoi and Haiphong in 1972, an effort which failed to produce victory. And you may recall Christmas 1991 and seeing the video of American soldiers bringing food to starving children in Somalia.

Clearly, Christmas is woven into the fabric of our military history. Nowhere was this history more charming, tragic, elegant, and memorable than in our own frontier army of 1865-1900. As you will see in A Frontier Army Christmas, these celebrations of Christmas were frequently dependent upon the whims of history and the fortunes of war.
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Lori A. Cox-Paul and Dr. James Wengert