Anger Control Training for Youth with Tourette Syndrome

描述（由申请人提供）：本申请申请资金用于完成一项正在进行的试点研究，该研究旨在研究认知行为、愤怒控制训练（ACT）对42名患有图雷特综合症（TS）和爆炸性、破坏性行为的青少年的有效性。在一项随机临床试验中，ACT将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的愤怒爆发被描述为愤怒攻击或愤怒风暴，因为它们的高强度和对最小挑衅的不可预测性。这些行为是否是TS的一部分，与合并症有关，还是由于慢性疾病的负担尚不清楚。然而，这些破坏性行为会导致严重的功能损害，通常需要临床关注。

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.