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| Advances in Behavioral Process Research for Pediatric Tic Disorders |
| Monday, May 25, 2015 |
| 11:00 AM–11:50 AM |
| Texas Ballroom Salon C (Grand Hyatt) |
| Area: CBM; Domain: Applied Research |
| Chair: Katie Wiskow (Texas Tech University) |
| Discussant: Thomas J. Waltz (Eastern Michigan University) |
| CE Instructor: Katie Wiskow, M.A. |
| Abstract: Behavior therapy is effective for pediatric tic disorders, and shows positive effect sizes comparable to widely-used psychopharmacological methods. Still, not all children with tics respond to behavior therapy, creating the need to examine basic therapeutic processes and ways to augment existing techniques. As such, this symposium will present two studies in line with these directions. First, Matthew Capriotti and will present an experimental study investigating fixed versus progressive reinforcement schedules for tic suppression. Given that tics can be suppressed for short time periods while being reinforced, perhaps more robust forms of reinforcement might increase suppression efforts and create greater resistance to reinforcement withdrawal. Second, David Houghton will present archival data from a recently conducted randomized controlled trial in which the hypothesized mechanisms of change in behavior therapy for tic disorders are tested. For some time, theorists have offered that habituation of premonitory urges (i.e., somatic phenomena that precede tics) drives treatment gains, but little data support this hypothesis. Alternatively, other behavioral processes, such as inhibitory learning, might better explain reductions in tic behavior. Finally, Thomas Waltz will close by discussing the implications of these findings with regard to the immediate applications as well as clinical behavior analysis in general. |
| Keyword(s): habituation, inhibitory learning, reinforcement schedule, tic management |
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| Comparing Fixed-Amount and Progressive-Amount DRO Schedules for Tic Suppression in Youth with Chronic Tic Disorders |
| MATTHEW CAPRIOTTI (University of Wisconsin-Milwaukee), Jennifer Turkel (University of Wisconsin-Milwaukee), Rachel Johnson (University of Wisconsin-Milwaukee), Flint Espil (University of Wisconsin-Milwaukee), Doug Woods (Texas A&M University) |
| Abstract: Chronic tic disorders (CTDs) involve multiple motor and/or vocal tics that occur repeatedly and cause substantial distress and functional impairment. Differential reinforcement of other behavior (DRO) schedules of reinforcement have been shown to decrease tics by ~80% in youth with CTDs; however, it is believed that a more robust reduction may enhance clinical change following withdrawal of the reinforcement contingency. Given that previously-used procedures (i.e., standard DRO schedules with token reinforcement) have not commonly yielded such reductions, we evaluated a novel, progressive-amount DRO schedule, based on its ability to facilitate sustained abstinence from functionally-similar target behaviors (i.e., substance use). Five youth with CTDs were exposed to alternating periods of baseline, traditional/fixed-amount DRO (DRO-F), and progressive-amount DRO (DRO-P) within the “tic detector” paradigm. Social validity was assessed via self-report and forced-choice preference assessment. Both fixed and progressive DRO schedules produced decreases in tic rate and median inter-tic interval, but no systematic differences were seen between the two schedules on any dimension of tic occurrence. The DRO-F schedule was generally preferred to the DRO-P schedule, which did not appear to yield any incremental effects. Possibilities for procedural improvements and other future directions are discussed. |
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| Inhibitory Learning as a Potential Mechanism of Change in Behavior Therapy for Tourette Syndrome |
| DAVID HOUGHTON (Texas A&M University), Matthew Capriotti (University of Wisconsin-Milwaukee), Lawrence Scahill (Emory University), Sabine Wilhelm (Massachusetts General Hospital), Alan Peterson (University of Texas Health Science Center at San Antonio), John Walkup (Weill Cornell Medical College), John Piacentini (University of California-Los Angeles School of Medicine), Doug Woods (Texas A&M University) |
| Abstract: Behavior therapy (BT) is an effective treatment for Tourette syndrome (TS), but the processes underlying treatment gains are poorly understood. BT might produce habituation of premonitory urges (PMUs); aversive somatic phenomena that precede tics. Alternatively, inhibitory learning, or the overwriting of maladaptive PMU-tic associations with newer ‘PMU toleration’ learning, might better explain tic reductions. The current study tested these models in a randomized controlled trial comparing BT to supportive psychotherapy for pediatric TS. Participants were 126 children/adolescents with tic disorders (Age Range: 9-17). A 2x3 (treatment x time) repeated measures ANOVA tested PMU strength over time, and showed no significant main effects or interaction. Additionally, a chi-square test of independence comparing PMU habituation to treatment response was non-significant. Comparatively, in testing the inhibitory learning model, we computed z-score discrepancy indices between premonitory urges and tics at both baseline and post-treatment. Results showed that urge-tic discrepancies were greater at post-treatment than baseline, and these discrepancies were greater in BT than controls. Changes in urge-tic discrepancy between baseline and post-treatment predicted treatment response and partially mediated the relationship between treatment and outcome. Implications for the processes of change in BT as well as the neurobiology of TS will be discussed. |
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