Emotional processing and executive functioning in children and adults with Tourette's syndrome

Abstract

Tourette's syndrome (TS) is predominantly a childhood disorder, with many of those who meet diagnostic criteria in childhood experiencing a remission of symptoms in adulthood. This indicates that the influence of TS on cognitive and emotional processing can best be understood by examining performance in both adults and children with TS. The present study examined emotional processing using a battery of face and prosody tasks with increasing levels of difficulty (same-different emotion discrimination, emotion naming, and emotion naming with conflict for prosody only). Experiment 1 compared the performance of children with TS-alone (n = 16) or TS+ADHD (n = 15) to healthy matched control children (n = 27). Compared to healthy control children, no significant group differences were found for those with TS-alone. Children with TS+ADHD showed subtle impairments on the more difficult emotion processing tasks relative to healthy control children, and differences were more pronounced for anger items (voice emotion naming, p < .05; voice emotion naming with conflict, p < .01). Experiment 2 compared the performance of adults with TS-alone (n = 23) to healthy matched controls (n = 21). No significant group differences were found, other than evidence of subtle impairment in the adults with TS-alone on the most complex task, again particularly for anger items (p < .05). Separate measurement of executive skills detected no evidence of impairment in children or adults with TS and little in the way of correlational evidence linking emotion recognition and executive skills. Implications of the findings for our understanding of emotion processing in TS are discussed.

A Review of the Neuropsychological Dimensions of Tourette Syndrome

“…However, the sample of TS-only patients in this study was rather small ( n = 11), making it hard to draw conclusions on this base. Finally, letter number sequencing is not affected in children with TS [ 90 ], which can be explained by the fact that much of the variance in this test is explained by digit span [ 91 ].…”

“…However, impairments were also found in non-comorbid patients [ 133 ]. Few studies found no impact of comorbidity on the Purdue Pegboard [ 90 ], the Grooved Pegboard [ 90 , 137 ] and the Finger tapping test [ 137 ]. While performance on the Purdue Pegboard was shown to improve following CBT [ 133 ], a recent study showed that performance on this task was unrelated to symptoms improvement following CBT in a very large sample of adults with TS [ 134 ].…”

“…For instance, some studies found no impact of ADHD on the cognitive flexibility of TS patients, measured either with the WCST [ 137 , 208 ] or the TMT [ 137 ]. Yet, better performance in the WCST [ 74 ] or the TMT [ 68 , 90 ] has also been reported in TS-only patients, when compared to TS + ADHD patients. Also, Brand et al [ 148 ] found weaker but not statistically different TMT Part B performance in TS + ADHD patients, which could be attributable to low power.…”

Fits, Tantrums, and Rages in TS and Related Disorders

“…Much evidence shows that rates of aggressive behaviors do not differ between subjects with TS and healthy controls, whereas those with comorbid TS+ADHD demonstrate similar rates of aggression as subjects with ADHD alone [56••, 62-66]. Children with TS and ADHD show subtle deficits in emotional-processing tasks, particularly of anger, relative to healthy controls and TS-affected children without ADHD [67]. A clinical study that compared problems with executive functioning in children with ADHD, ASD, and TS relative to healthy controls found increased problems with regulating emotions in children with TS [68•].…”

“…Maladaptive cognitions or problems processing external stimuli are associated with ADHD and OCD [72,99,108]. Children with TS+ADHD show subtle impairments on tasks measuring emotional processing compared to healthy controls or to children with TS only, especially when processing anger items [67]. Aggressionprone children suffering from ODD or other disruptive behaviors also experience cognitive deficits that contribute to maladaptive functioning [16••, 109-111].…”