An observational study of emotion regulation in children with Tourette syndrome

Abstract

Background: Explosive outbursts occur in 25%-70% of children with Tourette syndrome (TS) and may cause more distress than the tics themselves. Previous studies have indicated that a comorbid diagnosis of attention-deficit/ hyperactivity disorder (ADHD) is associated with emotional dysregulation in TS; however, this relationship has almost exclusively been studied using parent-reported questionnaires. Methods: We examined emotion regulation (ER) with an observational measure in 150 medication-na€ ıve children aged 7-12 allocated to four groups: Forty-nine children with TS, 23 children with ADHD, 16 children with TS + ADHD, and 62 typically developing controls. We assessed participants' ER ability, as well as parent-child interactions in the context of a complex puzzle task, and coded the observed behavior with the Tangram Emotion Coding Manual (TEC-M). We examined group differences in ER, as well as associations between ER and severity of symptoms pertaining to TS and ADHD. Results: Children with TS did not differ from controls in their ER ability. However, children with ADHD and TS + ADHD had more problems with ER than those with TS only and controls. Finally, parents of children with ADHD displayed more tension during the experimental task. ER ability was not associated with tic severity nor premonitory urges; however, better ER ability was associated with less severe symptoms of ADHD. Conclusions: This study is the first to evaluate ER with an observational, clinician-rated measure in a controlled social setting in children with TS. Our findings support earlier questionnaire-based studies by showing impaired ER in children with TS + ADHD, but not in children with TS without comorbidity. These findings inform our understanding of the phenomenology of emotional dysregulation in TS and the role of comorbid disorders.

Tourette syndrome research highlights from 2020

“…directly examined children with TS only, ADHD only, TS+ADHD, and controls. Emotional dysregulation was clearly dependent on the presence of ADHD and could not be observed in TS only ( Hagstrøm et al . 2021 ).…”

What underlies emotion regulation abilities? An innovative programme based on an integrative developmental approach to improve emotional competencies: Promising results in children with Prader–Willi syndrome

“…It would be worthwhile further investigating board games in this respect because they create a specific context that requires regulation skills in children ( 30 ). The coding system used in Hagstrøm et al’s ( 54 ) study or in Penela et al ( 55 ) also shows interesting possibilities.…”

How Do People Use Reappraisal? An Investigation of Selection Frequency and Affective Outcomes of Reappraisal Tactics

“…It is important to consider characteristics like age, gender, race, ethnicity, and clinical when interpreting patterns of reappraisal use and ability. For example, Hagstrøm et al (2020) found the ability to reappraise to be positively correlated with age, where older children tended to use a wider range of reappraisal tactics and regulate more effectively compared to younger children. Other studies found the use of change current circumstances and distancing to increase with age while the use of change future consequences and reality challenge to decrease (Nook et al, 2020).…”