Executive control of cognition, emotion and behavior in children with Tourette’s syndrome. A two-year follow-up study

• Main Author: Hovik, Kjell Tore
• Format: Dissertation
• Language: English

The ability to exert executive control over aspects of cognition, emotion and behaviour in children and adolescents with TS deviates from typically developing children (TDC), and represents a potential threat to their health and well-being. Knowledge about these processes and their development over time in young persons with TS is scarce, and is essential for understanding and treating this group of vulnerable children. In the first study, we found that children with TS were superior in inhibiting a prepotent response compared with children with Attention-deficit/Hyperactivity Disorder (ADHD) and TDC, and that co-occurring ADHD in the children with TS negatively influenced performance (Hovik, Plessen, Skogli, Andersen, & Oie, 2013). This finding provided evidence in support of the hypothesis that levels of inhibitory control can distinguish children with TS, ADHD and TDC, and that some children with TS may overly inhibit when responding to certain stimuli. In the second study, we found that paired scales in the Behavior Rating Inventory of Executive Function (BRIEF) dissociated everyday executive behavior difficulties in children with TS from children with ADHD-Combined type (ADHD-C), ADHD-Inattentive type (ADHD-I) or high-functioning Autism Spectrum Disorder (ASD) (Hovik et al., 2014). The parents of the children with TS reported more emotional control difficulties in their children relative to other executive behavior problems compared with the children in the other groups. This finding provided evidence in support of the hypothesis that having TS involves significant difficulties controlling emotional behaviour in their everyday lives. In the third study, we found that an improvement in executive functioning (working memory, inhibition and mental flexibility) over a two-year period was not closely associated with fewer symptoms of anxiety or depression or increased control over emotional behavior in the children with TS or ADHD-C (Hovik et al., 2015). Although there was a significant decrease in depression symptoms after two years in the children with TS, the self-reported level of depression and anxiety symptoms in these children remained significantly higher compared with the TDC at follow-up. Important clinical implications of the results from the third study include the importance of assessing and treating emotional symptoms in children and adolescents with TS or ADHD-C during a critical time in their maturational development. The third study also p