Anger Control Training for Youth with Tourette Syndrome

描述(由申请者提供)：本申请申请资金，以完成一项正在进行的关于认知-行为、愤怒控制训练(ACT)在42名患有抽动症(TS)和爆炸性、破坏性行为的青少年中的有效性的初步研究。ACT将在随机临床试验中与常规治疗进行比较。TS中的破坏性行为可能有多种形式，包括不服从、愤怒爆发和身体攻击。TS中的愤怒爆发被描述为愤怒攻击或愤怒风暴，因为他们对最小的挑衅反应的高强度和不可预测性。这些行为是TS的一部分，与共病条件有关，还是由于慢性病的负担尚不清楚。然而，这些破坏性行为会导致严重的功能障碍，通常需要临床关注。 ACT干预的目的是通过提高情绪调节和解决社会问题的能力来改善青少年TS患者的爆炸性和不顺从行为。这种治疗是基于愤怒控制训练(Feindler和Ecton，1986)，该训练已被经验支持，以减少攻击性行为和改善攻击性青年的社会功能。在Tourette综合征协会(TSA)为期一年的研究奖的资助下，我们的研究小组修改了治疗手册，以针对TS中发生的行为问题。到目前为止，我们招收了15名受试者。申请的资金将使我们能够继续这项研究，这将是第一次评估结构化认知行为疗法对TS患者破坏性行为问题的疗效。 这项研究将在耶鲁儿童研究中心与抽动障碍诊所、抽动症正在进行的项目项目(PO1MH49351)和儿科精神药理学研究单位(NO1MH7009)合作进行。主要结果测量包括对立违抗评定量表和临床医生全球改善评分，由临床医生对治疗分配视而不见进行评估。此外，还将探讨ACT对青少年抽动症状、愤怒体验和家庭功能的影响。在正常对照条件下治疗的受试者在10周后参加ACT。这一设计将允许展示在患有TS的青少年中进行愤怒控制训练的临床相关效应大小。

DESCRIPTION (provided by applicant): This application requests funding to complete an ongoing pilot study on the efficacy of a cognitive-behavioral, anger control training (ACT) in 42 adolescents with Tourette Syndrome (TS) and explosive, disruptive behavior. ACT will be compared to treatment as usual in a randomized clinical trial. Disruptive behaviors in TS may take numerous forms including noncompliance, anger outbursts, and physical aggression. Anger outbursts in TS have been described as rage attacks or rage storms due to their high intensity and unpredictability in response to minimal provocation. Whether these behaviors are part of TS, related to comorbid conditions, or due to the burden of chronic illness is not clear. Nevertheless, these disruptive behaviors can result in significant functional impairment and often require clinical attention. The purpose of this ACT intervention is to improve the explosive and noncompliant behavior in adolescents with TS by enhancing affect regulation and social problem-solving skills. The treatment is based on anger control training (Feindler and Ecton, 1986) which has been empirically supported for reducing aggressive behaviors and improving social functioning in aggressive youths. Funded by a one-year research award from the Tourette Syndrome Association (TSA), our research group has modified the treatment manual to target conduct problems that occur in TS. Thus far, we enrolled 15 subjects. The requested funding will allow us to continue the study, which will be the first to evaluate the efficacy of structured, cognitive-behavioral therapy for disruptive behavior problems in TS. The study will be conducted at the Yale Child Study Center in collaboration with the Tic Disorder Clinic, the ongoing Program Project in Tourette syndrome (PO1MH49351) and the Research Unit in Pediatric Psychopharmacology (NO1MH7009). The primary outcome measures include the Oppositional Defiant Scale and the Clinicians Global Improvement Score, to be assessed by a clinician blind to treatment assignment. In addition, the impact of ACT on adolescent's tic symptoms, anger experience, and family functioning will be explored. Subjects in the treatment as usual comparison condition participate in ACT after the 10-week period. This design will permit demonstration of a clinically relevant effect size for anger control training in adolescents with TS.