Subjective versus Objective Measures of Tic Severity in Tourette Syndrome – The Influence of Environment

The objective of this study was to examine the influence of environmental challenges on tic expression by subjective and objective measures. The study group consisted of 41 children aged 6–18 years (M=10.15, SD=2.73) with a primary diagnosis of Tourette syndrome. Subjective measures included the Functional Assessment Interview developed for this study and three standard validated instruments. The objective measure was a video-recording of the patients in five daily-life situations: watching television, doing homework, being alone, receiving attention when ticcing, and talking to a stranger. In addition, the effect of premonitory urges on assessment of tic expression was evaluated. The associations between the subjective and objective measures of tic expression were moderate to low. A significantly higher number of tics were observed in the television situation, and a significantly lower number in the alone situation, compared to the other situations. Higher levels of premonitory urge were associated with greater awareness of objectively measured tic expression. In conclusion, tic expression is significantly influenced by the environment. Subjective measures of tic expression may be misleading. These results have implications for refining the clinical assessment of tics, improving research methodology, and developing new therapeutic strategies

Cognitive Analytic Therapy in People with Learning Disability: An investigation into the common reciprocal roles found within this client group

Developments over the last twenty years have shown that, contrary to previous opinion, people with learning disabilities can benefit from psychotherapy (Sinason 1992; Kroese, Dagnan & Loumidia, 1997). Cognitive Analytic Therapy (CAT) has been adapted for use with a learning disability population (Ryle 2002). CAT collaboratively examines the Reciprocal Roles (RRs) a client plays in relationships. These are impacted by clients’ experiences of the world. The aim of this research is to identify which RRs may become apparent in working with people with learning disabilities. The therapy notes of participants (n=16) who had undergone CAT were examined and analysed using content analysis. Twenty-two different RRs were found. Four common Reciprocal Roles and two common idealised Reciprocal Roles were identified. Other observations about the data are presented. The limitations and clinical implications of the study are discussed