Development of Performance and ERPs in a Flanker Task in Children and Adolescents with Tourette Syndrome—A Follow-Up Study

Abstract

Background: Tourette Syndrome (TS) is a neurodevelopmental disorder with childhood-onset, with a typical decline in tic severity, as well as an increasing ability to suppress tics in late childhood and adolescence. These processes develop in parallel with general improvement of self-regulatory abilities, and performance monitoring during this age-span. Hence, changes in performance monitoring over time might provide insight into the regulation of tics in children and adolescents with TS.Method: We measured reaction time, reaction time variability, accuracy, and event-related potentials (ERP) in 17 children with TS, including 10 children with comorbid Attention-Deficit/Hyperactivity Disorder (ADHD), 24 children with ADHD, and 29 typically developing children, using a modified Eriksen Flanker task in two testing sessions administered on average 4.5 years apart. We then compared task performance, as well as ERP components across groups, and over time using regression models.Results: Task performance improved in all groups with age, and behavioral differences between children with TS and controls diminished at second assessment, while differences between controls and children with ADHD largely persisted. In terms of ERP, the early P3 developed earlier in children with TS compared with controls at the first assessment, but trajectories converged with maturation. ERP component amplitudes correlated with worst-ever tic scores.Conclusions: Merging trajectories between children with TS and controls are consistent with the development of compensatory self-regulation mechanisms during early adolescence, probably facilitating tic suppression, in contrast to children with ADHD. Correlations between ERP amplitudes and tic scores also support this notion.

Event-Related-Potential (ERP) Correlates of Performance Monitoring in Adults With Attention-Deficit Hyperactivity Disorder (ADHD)

“…In the subsequent P3 on the other hand, group differences were seen in incompatible trials, with lower amplitudes in ADHD than in the control group. This is in line with studies finding diminished P3 amplitudes in children with ADHD ( Johnstone et al, 2009 , 2010 ; Wild-Wall et al, 2009 ; Kratz et al, 2011 ; Eichele et al, 2016 , 2017 ) and adults ( McLoughlin et al, 2010 , 2011 ; Fisher et al, 2011 ; Szuromi et al, 2011 ). We saw no differences between groups in the compatible condition, indicating either specificity to levels of conflict, or more generally scaling of function with task demand (and hence a floor effect).…”

Neural correlates of performance monitoring in adult patients with Gilles de la Tourette syndrome: A study of event-related potentials

“…In contrast to the RT data, no GTS related enhancement was found with regard to the N2-amplitude congruency effect. This is in line with an earlier study in adolescents with GTS using a flanker task (Eichele et al, 2017) as well as studies in adult patients using other executive-functioning paradigms (Johannes et al, 2003;Petruo et al, 2018;Shephard et al, 2016). N2 amplitudes for both congruent and incongruent trials were negatively correlated with the obsessions subscale of the Y-BOCS.…”

“…That is, the patients' ERs and RTs were disproportionally enhanced in incongruent compared to congruent trials (Crawford et al, 2005). However, other studies in adolescents using the flanker task did not show abnormalities (Eichele et al, 2017;Eichele et al, 2017;Ozonoff et al, 1998).…”

“…Given that GTS is a neurodevelopmental disorder, our results may shed new light on the development of cognitive and neural functions in GTS. Specifically, cognitive deficits appear to diminish in adolescents over time, as seen in a longitudinal study on the Flanker task (Eichele et al, 2017). This appears to be compatible with the lack of group differences in error rates in our study.…”

“…It is considered to index performance monitoring (Falkenstein et al, 1990;Gehring et al, 1993;Ullsperger et al, 2014). In patients with GTS, Ne/ERN evidence on the flanker task is restricted to only one single study in adolescents that did not find amplitude differences between patients and controls (Eichele et al, 2017). Evidence from other paradigms showed enlarged Ne/ERN amplitudes in adult patients with GTS using a visual oddball task (Johannes et al, 2002) and a stopsignal task (Schüller et al, 2018).…”