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Tourette Syndrome and Tic Disorders

Research in the Division of Child and Adolescent Psychiatry

Prolonged Tic Suppression and Habituation to the Premonitory Urge

Principal Investigator: Matt W. Specht, Ph.D.

This study is sponsored by the Tourette Syndrome Association (TSA) to examine the means through which behavioral treatments produce reductions in tic symptoms.  A growing body of research supports the efficacy of behavioral treatments for Tourette Syndrome (TS) and tic disorders as an adjunct to medication or as a front-line intervention. Habit Reversal Training (HRT) is now considered a well-established treatment for reducing tic severity in children, adolescents, and adults. Critiques of behavioral treatments for tic disorders focus on the lack of large multi-site clinical trials and an established mechanism of action as well as concerns regarding potential negative treatment effects. The Comprehensive Behavioral Intervention for Tics (CBIT) study is intended to further address the efficacy of HRT. However, for psychosocial treatments to be widely accepted by practitioners, a mechanism of treatment action needs to be clarified and legitimate concerns need to be addressed.

The current study is designed to examine the Urge Habituation Hypothesis or the notion that urges subside under prolonged reinforced tic suppression and active component of HRT.  The current study is also designed to replicate and extend existing research regarding the negative reinforcement hypothesis of tic maintenance, the effects of attending to tics and prolonged tic suppression (i.e., symptom rebound), and the attention requirements of suppression.

Taken together these results will (a) further clarify the means by which tic suppression results in decreased tic symptoms, (b) provide further support for the negative reinforcement hypothesis of tic maintenance, (c) address concerns regarding potential negative treatment consequences, (c) improve treatment recommendations, and (d) facilitate the refinement behavioral treatments for tic disorders.

Study Contact:Matt W. Specht, Ph.D.
410-614-4236
mspecht1@jhmi.edu
Locations:600 North Wolfe Street/CMSC 341
Baltimore, MD 21287
VOLUNTEERS being recruited for this study - Click here if you are interested.

A Genetic Linkage Study of Tourette Syndrome

Principal Investigator: Marco Grados, M.D., M.P.H.

This international multisite study is sponsored by the Tourette Syndrome Association (TSA) and funded by the NIH in order to examine the genetic basis of Tourette Sydrome (TS). In a prior phase of this research, the TSA International Genetics Consortium completed two linkage studies which point to a region in the genome that might contain a susceptibility gene for GTS (2p). In the current phase additional fine-mapping strategies are planned to further pinpoint the localization of this gene and a new sample of informative families is being collected in order to replicate the prior finding. In addition, the research emphasizes the phenotypic analysis of the related disorders obsessive-compulsive disorder (OCD) and attention-deficit hyperactivity disorder (ADHD) in relation to TS. In conjunction with this grant, Dr. Grados, the Hopkins site Principal Investigator, has received research funding support from TSA to explore the relationship between TS, OCD and ADHD and their genetic determinants. For example, it is plausible that while TS and OCD can occur independent of each other, the occurrence together of TS and OCD, and of TS and OCD and ADHD, indictes a different or greater genetic loading that needs to be specifically examined. This research projects thus aims to understand the genetics basis of TS, as well as the etiological relationship of TS to OCD and ADHD.  

      Study Contact:

Marco Grados, M.D., M.P.H. 
443-287-2291     

Locations:

Home visits
The Johns Hopkins Hospital
Division of Child and Adolescent Psychiatry
CMSC 3
   
VOLUNTEERS being recruited for this study - Click here if you are interested.

Publications:

Tourette Syndrome Association International Consortium for Genetics. Genome scan for Tourette disorder in affected-sibling-pair and multigenerational families. Am J Hum Genet. 2007 Feb;80(2):265-72.

Grados MA, Walkup JT.A new gene for Tourette's syndrome: a window into causal mechanisms? Trends Genet. 2006 Jun;22(6):291-3.

 
 
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