Benchmarking Treatment Response in Tourette’s Disorder: A Psychometric Evaluation and Signal Detection Analysis of the Parent Tic Questionnaire

This study assessed the psychometric properties of a parent-reported tic severity measure, the Parent Tic Questionnaire (PTQ), and used the scale to establish guidelines for delineating clinically significant tic treatment response. Participants were 126 children ages 9 to 17 who participated in a randomized controlled trial of Comprehensive Behavioral Intervention for Tics (CBIT). Tic severity was assessed using the Yale Global Tic Severity Scale (YGTSS), Hopkins Motor/Vocal Tic Scale (HMVTS) and PTQ; positive treatment response was defined by a score of 1 (very much improved) or 2 (much improved) on the Clinical Global Impressions – Improvement (CGI-I) scale. Cronbach’s alpha and intraclass correlations (ICC) assessed internal consistency and test-retest reliability, with correlations evaluating validity. Receiver- and Quality-Receiver Operating Characteristic analyses assessed the efficiency of percent and raw-reduction cutoffs associated with positive treatment response. The PTQ demonstrated good internal consistency (α = 0.80 to 0.86), excellent test-retest reliability (ICC = .84 to .89), good convergent validity with the YGTSS and HM/VTS, and good discriminant validity from hyperactive, obsessive-compulsive, and externalizing (i.e., aggression and rule-breaking) symptoms. A 55% reduction and 10-point decrease in PTQ Total score were optimal for defining positive treatment response. Findings help standardize tic assessment and provide clinicians with greater clarity in determining clinically meaningful tic symptom change during treatment

The economics and ecology of alley cropping in the mid-western United States

Paper presented at the 12th North American Agroforesty Conference, which was held June 4-9, 2011 in Athens, Georgia.In Ashton, S. F., S.W. Workman, W.G. Hubbard and D.J. Moorhead, eds. Agroforestry: A Profitable Land Use. Proceedings, 12th North American Agroforestry Conference, Athens, GA, June 4-9, 2011.Our research involved examining the effects of alley cropping on insect biodiversity, crop yields, and small farm economics. We have investigated two alley cropping practices: a summer crop of alfalfa with black walnut and a winter crop rotation of canola and wheat with heartnut. We compared both practices at two alley widths to conventionally grown crops to determine which arrangement of crop and tree species produced the greatest return while providing the maximum ecological benefits. In the first practice with alfalfa, we found that alfalfa weevil mortality was significantly higher in alley cropped alfalfa compared to monocropped alfalfa, and that arthropod diversity was greater in alley cropped crops compared to conventionally grown crops. Alfalfa yield from wider alleyways was not significantly different from monocropped alfalfa. In the second practice with canola and wheat, alley cropping winter crops provided less competition with trees for water, nutrients and light while providing many of the same benefits found in the alfalfa-walnut system. Wheat yield was greater in monoculture than in wide or narrow alleyways, and greater in wide alleyways than in narrow alleyways the first rotation but not the second. All wheat treatments in both years produced economically significant returns. Canola yields were not significantly different between the alley cropped and monocropped treatments the first rotation. All canola treatments produced significant economic returns. Insect numbers in canola followed a similar pattern as those found in the alfalfa walnut practice, with more predators and greater diversity in the alley crops compared to the conventional crops. Our data suggest growing winter crops with nut trees can be a viable agronomic practice that provides ecological benefits as well.W.T. Stamps (1), J. Houx (1), L. Godsey (2) and T.L. Woods (1) ; 1. Division of Plant Sciences, University of Missouri, Columbia, MO, USA. 2. Center for Agroforestry, University of Missouri, Columbia, MO, USA.Includes bibliographical references

Neurocognitive Correlates of Treatment Response in Children with Tourette\u27s Disorder

This paper examined neurocognitive functioning and its relationship to behavior treatment response among youth with Tourette\u27s Disorder (TD) in a large randomized controlled trial. Participants diagnosed with TD completed a brief neurocognitive battery assessing inhibitory functions, working memory, and habit learning pre- and post-treatment with behavior therapy (CBIT, Comprehensive Behavioral Intervention for Tics) or psychoeducation plus supportive therapy (PST). At baseline, youth with tics and Attention Deficit Hyperactivity Disorder (ADHD) exhibited some evidence of impaired working memory and simple motor inhibition relative to youth with tics without ADHD. Additionally, a small negative association was found between antipsychotic medications and youth\u27s performance speed. Across treatment groups, greater baseline working memory and aspects of inhibitory functioning were associated with a positive treatment response; no between-group differences in neurocognitive functioning at post-treatment were identified. Within the behavior therapy group, pre-treatment neurocognitive status did not predict outcome, nor was behavior therapy associated significant change in neurocognitive functioning post-treatment. Findings suggest that co-occurring ADHD is associated with some impairments in neurocognitive functioning in youth with Tourette\u27s Disorder. While neurocognitive predictors of behavior therapy were not found, participants who received behavior therapy exhibited significantly reduced tic severity without diminished cognitive functioning

Functional Process Descriptions for the Program to Develop the Nuclear Waste Management System

The Office of Civilian Radioactive Waste Management (OCRWM) is executing a plan for improvement of the systems implemented to carry out its responsibilities under the Nuclear Waste Policy Act of 1982 (NWPA). As part of the plan, OCRWM is performing a systems engineering analysis of both the physical system, i.e., the Nuclear Waste Management System (NWMS), and the programmatic functions that must be accomplished to bring the physical system into being. The purpose of the program analysis is to provide a systematic identification and definition of all program functions, functional process flows, and function products necessary and sufficient to provide the physical system. The analysis resulting from this approach provides a basis for development of a comprehensive and integrated set of policies, standard practices, and procedures for the effective and efficient execution of the program. Thus, this analysis will form a basis for revising current OCRWM policies and procedures, or developing new ones is necessary. The primary purposes of this report are as follows: (1) summarizes the major functional processes and process flows that have been developed as a part of the program analysis, and (2) provide an introduction and assistance in understanding the detailed analysis information contained in the three volume report titled The Analysis of the Program to Develop the Nuclear Waste Management System (Woods 1991a)

Investigating Habituation to Premonitory Urges in Behavior Therapy for Tic Disorders

Behavior therapy is effective for Persistent Tic Disorders (PTDs), but behavioral processes facilitating tic reduction are not well understood. One process, habituation, is thought to create tic reduction through decreases in premonitory urge severity. The current study tested whether premonitory urges decreased in youth with PTDs (N = 126) and adults with PTDs (N = 122) who participated in parallel randomized clinical trials comparing behavior therapy to psychoeducation and supportive therapy (PST). Trends in premonitory urges, tic severity, and treatment outcome were analyzed according to the predictions of a habituation model, whereby urge severity would be expected to decrease in those who responded to behavior therapy. Although adults who responded to behavior therapy showed a significant trend of declining premonitory urge severity across treatment, results failed to demonstrate that behavior therapy specifically caused changes in premonitory urge severity. In addition, reductions in premonitory urge severity in those who responded to behavior therapy were significant greater than those who did not respond to behavior therapy but no different than those who responded or did not respond to PST. Children with PTDs failed to show any significant changes in premonitory urges. Reductions in premonitory urge severity did not mediate the relationship between treatment and outcome in either adults or children. These results cast doubt on the notion that habituation is the therapeutic process underlying the effectiveness of behavior therapy, which has immediate implications for the psychoeducation and therapeutic rationale presented in clinical practice. Moreover, there may be important developmental changes in premonitory urges in PTDs, and alternative models of therapeutic change warrant investigation

Moderators and Predictors of Response to Behavior Therapy for Tics in Tourette Syndrome

Objective: To examine moderators and predictors of response to behavior therapy for tics in children and adults with Tourette syndrome and chronic tic disorders. Methods: Data from 2 10-week, multisite studies (1 in children and 1 in adults; total n = 248) comparing comprehensive behavioral intervention for tics (CBIT) to psychoeducation and supportive therapy (PST) were combined for moderator analyses. Participants (177 male, 71 female) had a mean age of 21.5 ± 13.9 years (range 9–69). Demographic and clinical characteristics, baseline tic-suppressing medication, and co-occurring psychiatric disorders were tested as potential moderators for CBIT vs PST or predictors of outcome regardless of treatment assignment. Main outcomes measures were the Yale Global Tic Severity Scale Total Tic score and the Clinical Global Impression–Improvement score assessed by masked evaluators. Results: The presence of tic medication significantly moderated response to CBIT vs PST (p = 0.01). Participants showed tic reduction after CBIT regardless of tic medication status, but only participants receiving tic medication showed reduction of tics after PST. Co-occurring psychiatric disorders, age, sex, family functioning, tic characteristics, and treatment expectancy did not moderate response. Across both treatments, greater tic severity (p = 0.005) and positive participant expectancy (p = 0.01) predicted greater tic improvement. Anxiety disorders (p = 0.042) and premonitory urge severity (p = 0.005) predicted lower tic reduction. Conclusions: Presence of co-occurring attention-deficit/hyperactivity disorder, obsessive-compulsive disorder, or anxiety disorders did not moderate response to CBIT. Although participants on tic medication showed improvement after CBIT, the difference between CBIT and PST was greater for participants who were not on tic-suppressing medication. ClinicalTrials.gov identifiers: The child and adult CBIT studies are listed on clinical trials.gov (NCT00218777 and NCT00231985, respectively). Classification of evidence: This study provides Class I evidence that CBIT is effective in reducing tic severity across subgroups of patients with chronic tic disorders, although the difference between treatments was smaller for participants on tic-suppressing medications, suggesting reduced efficacy in this subgroup

Developing learning materials to promote positive interaction with people with dementia: we are all in it together!

Literature on the care of people with dementia is still sparse and this is reflected in the professional education curriculum such as social work, nursing and other health care professionals (Marshall and Tibbs 2006). As life expectancy and the likelihood of dementia increases, the transition from the third to the fourth age is marked by a loss of control of the body through dementia. Its effects on the person constitutes what Gilleard and Higgs(2000) term a ‘loss of social agency’; a social death that is characterised by an exclusion from the social world and services that objectify and dehumanise the individual (Foucault 1973). Extensive research by Kitwood (1997) centred on engagement through intense interaction with individuals with dementia and promoted the concept of ‘personhood’ bringing to the forefront more person-centred and citizen approaches to dementia care (Kitwood, 1997, Marshall and Tibbs, 2006). This approach has also connected with a number of arts based methods in professional education where traditional care practices founded on more positivist stances are recognised to be limited as a basis for enquiry into the human condition. This paper describes an educational partnership between social work and nurse educators, carers of people with dementia and an older people’s theatre project. This collaboration sought to build on cultural theories from the arts and humanities to provide a more political lens for change and reform in approaches to dementia care (Deleuze and Guttari , 1987; Barrett and Bolt 2007). Using storytelling techniques, a number of case studies were developed to inform arts based approaches such as drama and music to develop learning materials for professional and carer education. Digital images enacted by an older people’s theatre group also drew on research evidence of good practice in communication with people with dementia and a number of digital stories were developed. The paper will present some of the findings from the evaluation of the project and will illustrate this by showing some of the 3 – 4 minute clips from materials developed to facilitate further participant discussion

An Empirical Examination of Symptom Substitution Associated with Behavior Therapy for Tourette\u27s Disorder

Over the past six decades, behavior therapy has been a major contributor to the development of evidence-based psychotherapy treatments. However, a long-standing concern with behavior therapy among many nonbehavioral clinicians has been the potential risk for symptom substitution. Few studies have been conducted to evaluate symptom substitution in response to behavioral treatments, largely due to measurement and definitional challenges associated with treated psychiatric symptoms. Given the overt motor and vocal tics associated with Tourette’s disorder, it presents an excellent opportunity to empirically evaluate the potential risk for symptom substitution associated with behavior therapy. The present study examined the possible presence of symptom substitution using four methods: (a) the onset of new tic symptoms, (b) the occurrence of adverse events, (c) change in tic medications, and (d) worsening of co-occurring psychiatric symptoms. Two hundred twenty-eight participants with Tourette’s disorder or persistent motor or vocal tic disorders were randomly assigned to receive behavioral therapy or supportive therapy for tics. Both therapies consisted of eight sessions over 10 weeks. Results indicated that participants treated with behavior therapy were not more likely to have an onset of new tic symptoms, experience adverse events, increase tic medications, or have an exacerbation in co-occurring psychiatric symptoms relative to participants treated with supportive therapy. Further analysis suggested that the emergence of new tics was attributed with the normal waxing and waning nature of Tourette’s disorder. Findings provide empirical support to counter the long-standing concern of symptom substitution in response to behavior therapy for individuals with Tourette\u27s disorder