L’incidence des troubles associés sur l’effet d’une psychothérapie ciblant les épisodes explosifs chez des enfants ayant le syndrome de Gilles de la Tourette

Abstract

The present study examines whether the severity of inattention and hyperactivity symptoms as well as the severity of obsessions and compulsions symptoms modulate the response to a specialized psychotherapy that aims to decrease the explosive outburst (EO) in children with Tourette syndrome (TS). Indeed, the impulsivity and lack of self-control usually associated to attention-deficit/hyperactivity disorder (ADHD), paired with the rigidity and perfectionism inherent in obsessive–compulsive disorder (OCD) increases the likelihood of EO manifestation. However, no study has directly examined the interactions between the specific symptoms of ADHD and OCD in the treatment of EO. Nineteen children with TS, aged 8 to 14, were recruited and randomly assigned to one of two intervention groups: 1) a specific therapy to reduce EO; 2) an active control group. To our knowledge, the specific therapy named “Prends ton Tourette par les Cornes !” (PTC) (Leclerc, O’Connor, Forget, & Lavoie, 2012) is the only therapy that addresses specifically EO. Moreover, this therapy conceptualises EO as inherent manifestations of TS and takes into account certain cognitive processes inherent in ADHD and OCD, such as cognitive rigidity and lack of self-control. Data were collected regarding the severity of tics and the severity of comorbid ADHD and OCD symptoms. The severity of ADHD symptoms tends to have a negative impact on the effect of the therapy (r=−0.694; P=0.056), unlike OCD symptoms (r=0.039; P=0.920) and the severity of tics (r=0.262; P=0.155). However, the lack of association between the severity of OCD symptoms and the response to treatment can be explained by the low prevalence of these symptoms in the sample prior to the treatment. Regression coefficients analysis shows that the inattention subscale of the ADHD questionnaire is the most negatively associated (r=−0.642) with the reduction of EO after PTC therapy, without however reaching the threshold of statistical significance (P=0.086). Data shows that the presence of ADHD accounts for 48.10% of the variance in EO after therapy and that inattention symptoms could affect the effectiveness of treatment. In short, inattention behaviour prior to the therapy could make it more difficult to process information and ultimately interfere with the integration of therapeutic steps or with the adhesion of essential elements of the therapy. Consequently, ADHD symptoms should be taken into account from the start and be directly targeted by the addition of specific exercises for attentional difficulties, while considering the parents’ urgency to address EO quickly in the therapeutic process. Future studies examining the association between EO and comorbid disorders would benefit from being part of a transdiagnostic current in order to clarify the role of symptoms and cognitive or emotional processes present in the broad spectrum of associated symptoms in children with TS.