Tourette-like behaviors in the normal population are associated with hyperactive/impulsive ADHD-like behaviors but do not relate to deficits in conditioned inhibition or response inhibition

Abstract

Attention-Deficit Hyperactivity Disorder (ADHD) and Tourette Syndrome (TS) present as distinct conditions clinically; however, comorbidity and inhibitory control deficits have been proposed for both. Whilst such deficits have been studied widely within clinical populations, findings are mixed—partly due to comorbidity and/or medication effects—and studies have rarely distinguished between subtypes of the disorders. Studies in the general population are sparse. Using a continuity approach, the present study examined (i) the relationships between inattentive and hyperactive/impulsive aspects of ADHD and TS-like behaviors in the general population, and (ii) their unique associations with automatic and executive inhibitory control, as well as (iii) yawning (a proposed behavioral model of TS). One hundred and thirty-eight participants completed self-report measures for ADHD and TS-like behaviors as well as yawning, and a conditioned inhibition task to assess automatic inhibition. A sub-sample of fifty-four participants completed three executive inhibition tasks. An exploratory factor analysis of the TS behavior checklist supported a distinction between phonic and motor like pure TS behaviors. Whilst hyperactive/impulsive aspects of ADHD were associated with increased pure and compulsive TS-like behaviors, inattention in isolation was related to reduced obsessive-compulsive TS-like behaviors. TS-like behaviors were associated with yawning during situations of inactivity, and specifically motor TS was related to yawning during stress. Phonic TS and inattention aspects of ADHD were associated with yawning during concentration/activity. Whilst executive interference control deficits were linked to hyperactive/impulsive ADHD-like behaviors, this was not the case for inattentive ADHD or TS-like behaviors, which instead related to increased performance on some measures. No associations were observed for automatic conditioned inhibition.

Gray’s revised Reinforcement Sensitivity Theory in relation to Attention-Deficit/Hyperactivity and Tourette-like behaviors in the general population

“…Indeed, pure TS may rather be characterized by enhanced executive control (Jackson et al, 2007;Jung et al, 2014) and there is no evidence for automatic inhibitory deficits in TS patients without comorbidity (Ozonoff et al, 1998;Yuen et al, 2005) and independent of medication effects (Kantini et al, 2011). Similar findings were recently shown in relation to TS-like behaviors in the general population when ADHD was controlled for (Heym, Kantini, Checkley & Cassaday, 2014). These findings suggest that TS does not occur in conjunction with deficits in effortful or automatic associative response inhibition.…”

“…Tourette-like behaviors were assessed using the 18-item TS behavior checklist based on frequency occurrence of DSM-IV and ICD10 symptoms for TS (except common complex tics as these would be unlikely in an undiagnosed population) and with a similar question format to the ASRS 1 (Heym et al, 2014). The scale comprises two pure TS subscales: TS-phonic (8 items) related to sounds produced through the nose, mouth or throat (e.g., throat clearing, coughing, sniffing), and TS-motor (7 items) related to unintentional physical movements (e.g., blinking, face twitches, random body movements).…”

Stable Individual Differences in Occasion Setting

“…There are few examples in which it has been studied alongside other measures of inhibition (e.g., Stroop Task, Stop-Signal Reaction Time) or in relation to disorders in which inhibition is impaired. Among the studies where conditioned inhibition has been examined there have been reports of weaker conditioned inhibition linked to schizotypy, schizophrenia, and personality disorders (He, Cassaday, Howard, Khalifa, & Bonardi, 2011; He, Cassaday, Park, & Bonardi, 2012; Migo et al, 2006) but no evidence of a link between conditioned inhibition and Tourette’s Syndrome (Heym, Kantini, Checkley, & Cassaday, 2014) nor between conditioned inhibition and behavioral inhibition as measured by the BIS component of the BIS-BAS questionnaire (Carver & White, 1994; He et al, 2013). It is difficult to draw strong conclusions given the number of studies of this kind that currently exists but one lesson from the current research is that a finer grained analysis may be useful.…”

Safety Learning in Anxiety, Pavlovian Conditioned Inhibition and COVID Concerns

“…The two test method to confirm conditioned inhibition (by both summation and retardation tests) has been widely adopted in animal studies, but has been harder to implement in human studies. In human studies, there have been some reports of conditioned inhibition confirmed by summation test ( He et al, 2013 ; Heym et al, 2014 ; Thurston and Cassaday, 2015 ) but these have been relatively few ( Sosa and dos Santos, 2019 ; Sosa and Ramίrez, 2019 ). Indeed, it has been argued that studies of feature negative inhibitory discrimination learning of the kind typically used to successfully demonstrate conditioned inhibition, but which do not include (or do not subsequently pass) the formal tests to confirm conditioned inhibition should also be considered ( Sosa and dos Santos, 2019 ; Sosa and Ramίrez, 2019 ).…”