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

Ten Tips for a Peaceful Holiday Season: Helping Kids Relax

From Patti Teel
Kids get pretty anxious over the holidays. It’s a time of excitement and wonder, and they often have a hard time relaxing, staying calm and sleeping well. Here are some tips to help your kids stay relaxed and on a healthy sleep schedule.
1. Don't overschedule your children. Cut back on the tasks and activities which are likely to overwhelm them. For example, avoid long trips to the mall with young children; short spurts of shopping will be more fun for everyone. Don't try to
change your child's temperament; accept that he or she may be naturally timid and soft-spoken, or boisterous and loud. An activity level that might be comfortable for one child could be overwhelming for another—even in the same family.
2. Have activity-based celebrations. For instance, spend time with children making cards, decorations, cookies and gifts. You may wish to let each child select one activity for the whole family to do over the holidays.
3. Have children stay physically active. Don't allow busy holiday schedules to crowd out active play time. Physical activity is one of the simplest and most effective ways to reduce stress and ensure that a child gets a good night’s sleep. Children
should have at least 30 minutes of moderate-intensity activity every day. (However, vigorous activities should not be done within several hours of bedtime because it raises the metabolic rate and may make it difficult for your child to relax.)
4. When possible, have your children play outdoors. Exposure to daytime sunlight helps children to sleep better at night.
5. Teach your children relaxation skills such as stretching, progressive relaxation, deep breathing and guided visualization. Relaxation can be a delightful form of play and it’s easy to incorporate the holidays in imaginative ways. For example, play a relaxing game of “Santa Says.” Direct children to stretch and relax by curling up like a snowball, to move their arms and legs slowly in and out like a snow angel, or to open their mouths widely to catch snowflakes.
6. Banish bedtime fears and help kids put worries to bed. Make a ceremony out of putting worries or fears away for the night. Have children pretend, or actually draw a picture of what’s bothering them. Fold, (or pretend to fold) the worry or fear
until it’s smaller and smaller. Then put it away in a box and lock it with a key. It’s often helpful for older children and teens to list their worries in a journal before putting them away for the night.
7. Make your home a sanctuary from the overstimulation of the outside world by making family “quiet time” a part of every evening.
• Limit total screen time, including computer games, video games and time spent watching television. Advertisements scandalously target children and the more they watch, the more they soak up the commercial messages of the season…instead of the real spirit of the holidays.
• Tell or read inspiring holiday stories.
• Sing and listen to soothing holiday music.
• Give each other a gentle massage.
8. Maintain the bedtime routine. While routines are likely to be thrown off during the holidays, it’s important to maintain a consistent bedtime, allowing plenty of time for a relaxed bedtime routine. Don't let holiday parties or activities interfere with your child getting a good night’s sleep.
9. Instill compassion and encourage generosity.
• Provide opportunities for your children to help others. Opportunities abound: have your child draw pictures and help bake and deliver food, encourage them to donate some or their clothes, toys or books; or regularly visit an elderly
person who needs companionship.
• Read or tell stories that emphasize giving.
• Perform simple rituals to symbolize your care for others. Light a candle as you and your children send your good wishes or say a prayer for those who are in need.
10. Instill appreciation and gratitude. It’s not possible to be upset and worried while feeling appreciative. Share good things that happened during your day and have your child do the same. They don't need to be major events; emphasize
actions that demonstrate the blessings of the season. It could be a hug, words of love, the sound of the birds in the morning or a beautiful snowfall. Depending on your beliefs, you may wish to incorporate prayers of appreciation and thankfulness.
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Major Depression in Children and Adolescents

Major Depression in Children and Adolescents
What are mental health problems?

How many children and adolescents are affected by these problems?

What is depression?

What are the signs of depression?

How common is depression?

What help is available for a young person with depression?

What can parents do?

Important messages about children's and adolescents' mental health:

What are mental health problems?

In this fact sheet, "mental health problems" for children and adolescents refers to the range of all diagnosable emotional, behavioral, and mental disorders. They include depression, attention- deficit/hyperactivity disorder, and anxiety, conduct, and eating disorders.
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How many children and adolescents are affected by these problems?

Mental health problems affect one in every five young people at any given time. "Serious emotional disturbances" for children and adolescents refers to the above disorders when they severely disrupt daily functioning in home, school, or community. Serious emotional disturbances affect 1 in every 10 young people at any given time.
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What is depression?

Major depression is one of the mental, emotional, and behavior disorders that can appear during childhood and adolescence. This type of depression affects a young person's thoughts, feelings, behavior, and body. Major depression in children and adolescents is serious; it is more than "the blues." Depression can lead to school failure, alcohol or other drug use, and even suicide.
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What are the signs of depression?

Young people with depression may have a hard time coping with everyday activities and responsibilities, have difficulty getting along with others, and suffer from low self-esteem. Signs of depression often include:


sadness that won't go away;
hopelessness, boredom;
unexplained irritability or crying
loss of interest in usual activities;
changes in eating or sleeping habits;
alcohol or substance abuse
missed school or poor school performance;
threats or attempts to run away from home;
outbursts of shouting, complaining;
reckless behavior;
aches and pains that don't get better with treatment;
thoughts about death or suicide.
Adolescents with major depression are likely to identify themselves as depressed before their parents suspect a problem. The same may be true for children.
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How common is depression?

Population studies show that at any point in time 10 to 15 percent of children and adolescents have some symptoms of depression. Having a family history of depression, particularly a parent who had depression at an early age, also increases the chances that a child or adolescent may develop depression. Once a young person has experienced a major depression, he or she is at risk of developing another depression within the next 5 years. This young person is also at risk for other mental health problems.
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What help is available for a young person with depression?

While several types of antidepressant medications can be effective to treat adults with depression, these medications may not be as effective in treating children and adolescents. Care must be used in prescribing and monitoring all medication.

Many mental health care providers use "talk" treatments to help children and adolescents with depression. A child or adolescent in need of treatment or services and his or her family may need a plan of care based on the severity and duration of symptoms. Optimally, this plan is developed with the family, service providers, and a service coordinator, who is referred to as a case manager. Whenever possible, the child or adolescent is involved in decisions. This "system of care" is designed to improve the child's ability to function in all areas of life--at home, at school, and in the community. For more information on systems of care, call 1.800.789.2647.
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What can parents do?

Make careful notes about the behaviors that concern them. Note how long the behaviors have been going on, how often they occur, and how severe they seem.
Make an appointment with a mental health professional or the child's doctor for evaluation and diagnosis.
Get accurate information from libraries, hotlines, or other sources.
Ask questions about treatments and services.
Talk to other families in their community.
Find family network organizations.
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Important messages about children's and adolescents' mental health:

Every child's mental health is important.
Many children have mental health problems.
These problems are real and painful and can be severe.
Mental health problems can be recognized and treated.
Caring families and communities working together can help.
Information is available-publications, references, and referrals to local and national resources and organizations-call 1.800.789.2647; (TDD) 866-889-2647 or go to http://mentalhealth.samhsa.gov.