Translational Research to Enhance Cognitive Control

慢性抽动障碍，包括抽动秽语综合征（CTD）是一种相对常见的， 儿童期神经发育障碍CTD与认知控制缺陷有关，包括 工作记忆和反应抑制，以及皮质-纹状体回路功能障碍。虽然药物 针对这些回路在减少CTD症状方面有一定的效果， (HRT)，一种行为技术，已经显示出在提供持久的症状缓解而没有严重的 药物治疗的副作用。本项目旨在阐明 解剖CTD青少年中有助于认知控制的关键回路，以检查假设的 与HRT相关的认知增强机制，并将这些机制与那些 用于ADHD的药物治疗。确定行为的神经基础 干预措施，如HRT，并建立这些结果的普遍性，有可能 显著促进CTD治疗策略的改进，包括 为个别患者提供最佳治疗方案。因此，这些目标高度一致， CIDAR的总体目标。共有60名患有DSM-IV慢性抽动障碍的青少年（7-16岁）将 接受为期八周的HRT，使用我们开发和先前测试的手动治疗方案。 组青少年还将在基线时接受全面的临床，认知/EEG和fMRI评估 和后处理。还将在治疗期间收集临床和认知/EEG组合的减少， 3个月随访（仅限应答者），以检查应答的过程和持久性。 所有参与者将由 研究评估单位（RAU）也将招募正常对照的匹配样本，以允许 与CTD和项目III ADHD患者样本的基线临床、EEG/fMRI比较。功能磁共振成像和 研究的EEG/认知部分将通过与成像和 研究方法（RMC）核心。最后，本项目的治疗相关发现将 系统地与项目III的结果进行比较，以记录神经系统的潜在共性。 多种疾病和治疗方式的治疗反应机制。

Chronic Tic Disorder, including Tourette Syndrome, (CTD) is a relatively common and typically impairing neurodevelopmental disorder of childhood. CTD is associated with deficits in cogntive control, including working memory and response inhibition, and dysfunction of cortico-striatal circuits. Although medications targeting these circuits have been moderately effective in reducing CTD symptoms, Habit Reversal Training (HRT), a behavioral technique, has shown efficacy in providing durable symptom relief without the serious side effects associated with pharmacotherapy. This project aims to clarify the functional anatomy of key circuits subserving cognitive control in youngsters with CTD, to examine hypothesized mechanisms of cognitive enhancement associated with HRT, and to compare these mechanisms to those identified for medication treatment of ADHD. Determining the neural basis of behavioral interventions, such as HRT, and establishing the generalizability of these findings, has the potential to significantly enhance development of improved treatment strategies for CTD, including the development of optimal treatment regimes for individual patients. As such, the aims are highly consistent with the overal goals of the CIDAR. A total of 60 youngsters (aged 7-16) with a DSM-IV Chronic Tic Disorder will receive eight weeks of HRT using a manualized treatment protocol developed and previously tested by our group. Youngsters will also undergo comprehensive clinical, cognitive/EEG, and fMRI evaluation at baseline and post-treatment. A reduced clinical and cognitive/EEG battery will also be collected mid-treatment and three month follow-up (responders only) to examine course and durability of response. All participants will be initially recruited and screened by the Research Assessment Unit (RAU) which will also recruit a matched sample of normal controls to allow for baseline clinical, EEG/fMRI comparison with the CTD and Project III ADHD patient samples. The fMRI and EEG/Cognitive components of the study will be executed through close collaboration with the Imaging and Research Methods (RMC) Cores, respectively. Finally, treatment-related findings from this project will be systematically compared to those from Project III in order to document the potential commonality of neural mechanisms of treatment response across multiple disorders and treatment modalities.