The basic rule of thumb is to ask your child. Five participants loaded onto Factor 3, explaining 21 % of the variance. Google Scholar. Finally, attendance of significant others (e.g., teachers, friends) was contested (Factor 1) and endorsed (Factor 3). Computer software and manual. Medication may be recommended in some severe cases. Despite recognition of the importance of family education and support (Verdellen et al. Tic disorders affect up to 20 percent of all children at some time, and adults less so. 42, 403–424. The need for providing specific tic-related knowledge to parents was agreed, (s15:‘Providing education about tics is important in a parenting intervention for TSC’; +3), and (s16:‘Providing information about medication (e.g., benefits, side effects) is important in a parenting intervention for TSC’; +2), and a lack of professional knowledge around tic disorders was perceived as an intervention obstacle (s73:‘A lack of training and knowledge about TSC is a barrier to non-specialist services offering parenting interventions for TSC’; +4). Journal of Psychiatric and Mental Health Nursing, Journal of Autism and Developmental Disorders, volume 25, pages1594–1604(2016)Cite this article. Examples of tics in children include squinting, hand flapping, contracting shoulder muscles, repetitive frowning, licking lips, or rapid blinking. Twenty-five professionals’ views on the acceptability, effectiveness, feasibility and utility of parenting interventions were explored using Q-methodology. 37, 1203–1214. Furthermore, environmental, social and emotional factors can influence tic severity (Robertson and Cavanna 2008), thus, parental management and problematic family functioning may inadvertently contribute to tic exacerbation, which may heighten familial stress; creating a reciprocal cycle. Vocals tics can be especially problematic in the school setting,” says Dr. Zupanc. Providing a separate test location where the child can tic without disturbing others can let them focus on the test, rather than their tic. Children may experience social, cognitive and emotional difficulties (Robertson and Cavanna 2008; Storch et al. . Sometimes a person will have 1 or 2 tics for many years. Clonidine and guanfacine, types of anti-hypertensive agents, may also be used for mild to moderate tics and may be better tolerated than the neuroleptics.2 Living with tics: Reduced impairment and improved quality of life for youth with chronic tic disorders. (2000). Her parents co-founded the IL TS chapter along with several others, including Joe Bliss. Sukhodolsky, D., Scahill, L., Zhang, H., Peterson, B., King, R., Lombroso, P., & Leckman, J. Most had psychological backgrounds; however, many were still undertaking professional training. Further research should determine the benefits and disadvantages in tic populations. Anja Wittkowski. The movements and sounds may change over time. Consider a Behavior Modification Plan: Some older children and teens with Tourette's are able to reduce the number of tics they experience by using behavior modification techniques. Tics themselves are relatively common and are mildly and transiently experienced by around 10 % of children (Verdellen et al. For example, RCT studies have shown positive effects of parent-based interventions for children with intellectual disabilities/developmental delay (Leung et al. Research into parenting interventions within this population is limited. Tourette's syndrome. (2010). Save my name, email, and website in this browser for the next time I comment. Quotes from post-sort questions are provided to supplement findings. Article  The constant need to be perfect will make your child anxious. His tics come pretty fast and furious, and when they do, his body is involuntarily thrust into contortions, with a variety of barks and other verbal tics bursting from his mouth. Journal of Child Neurology, The project was advertised through a tic disorders charity, specialist tic disorders service and a paediatric interest mailing group. This structured programme included core skills such as providing positive reinforcement for appropriate behavior (token economies, positive attending), discouraging negative behaviour (consistent consequences, selective ignoring, time-out), and communication (communicating directions effectively) (Scahill et al. Similarly, McGuire et al. Previous parenting programmes in other populations have varied in terms of audience (e.g., Lee et al. 42, 98–105. Tics are like itches – the more you think about not scratching, the more you want to do it. Absalom-Hornby, V., Hare, D., Gooding, T., & Tarrier, N. (2012). Professionals did not strongly advocate the need for tic-specific professional expertise or for individual interventions, (s59:‘Professionals who run parenting groups for TSC must be experts in the treatment of tics’; −3) and (s46:‘Parents need to discuss their child’s difficulties on an individual basis’; −3). 35(2), 180–193. 2011), this area is under-researched. European clinical guidelines for Tourette syndrome and other tic disorders. Avoid artificial colors, flavors and preservatives. 2000). 2007), while parents may experience increased stress and negative life events (Cooper et al. In terms of effectiveness, professionals disagreed that biological or pharmacological approaches to tic disorders negates the effectiveness of psychological interventions (s26:‘TSC are biological in origin so a parenting intervention will have no effect’; F1 = −5, F2 = −6, F3 = −5), and (s70:‘Medication is more effective than psychological interventions for TSC’; F1 = −4, F2 = −3, F3 = −3). “Often times, the biggest treatment of tics is reassurance to the child and family, in addition to providing education on when it is appropriate to suppress a tic or not. 321, 694–696. Knight, T., Steeves, T., Day, L., Lowerison, M., Jette, N., & Pringsheim, T. (2012). Qualitative Research in Psychology, 21, 650–656. Evans, G.A.L., Wittkowski, A., Butler, H. et al. Barkley, R. (1997). The study explored twenty-five professionals’ opinions on parenting interventions in tic disorders. Group implementation was endorsed given social benefits, (s40:‘Social support from other parents is an important benefit of a group-based parenting intervention’; F1 = +3, F2 = +4, F3 = +5). Indeed, this statement was highly endorsed, and emerged as a shared opinion amongst factors (F1 = +4, F2 = +6, F3 = +4). Your email address will not be published. Group-based interventions were supported on financial grounds, (s48:‘Group-based parenting interventions for TSC are cost effective’; +6), and professionals encouraged wide attendance of significant others (s72:‘Family members, friends, and teachers should be invited to attend parenting interventions for TSC’; +2). The focus on parental cognitions may therefore be underpinned by their systemic and reflective training backgrounds alongside common issues experienced through delivering parenting interventions across different populations. Hoath, F. E., & Sanders, M. R. (2002). Piacentini, J., Woods, D., Scahill, L., Wilhelm, S., Peterson, A., et al. The value of the current study, however, is that it innovatively demonstrates this assumed likelihood in an empirical manner. Chronic tics occur in less than 5 in 100 children. This suggests that some participants were not those who had particularly extensive professional experience of tic disorders; a scenario which could have potentially introduced bias into the sample. Telling a child with TS to “be still” is insulting, I feel, and may do damage to their self-esteem. Unlike most children with Tourette syndrome, Jaylen started experiencing symptoms very early in life -- his first tic developed at age 2. Tic disorders can have an emotional and social impact on children and families, which can in turn have a reciprocal impact on tics. The onset may be … 37(4), 469–480. Q-sorts were completed via a secure website link. Webster-Stratton, C., Reid, J., & Beauchaine, T. (2011). Some tics do not go away. © 2021 Springer Nature Switzerland AG. JAMA, Leung, C., Fan, A., & Sanders, M. (2013). Themes were extracted and representative statements generated (n = 244) which were reviewed and refined by the research team to produce 73 final statements. Parenting Interventions for Children with Tic Disorders: Professionals’ Perspectives. The value placed on delivering functional strategies to parents may therefore reflect their training stage, with perhaps greater focus on relaying learnt techniques. The adults in that child’s life need to learn how to support the child without insisting on medication or suppressing the tics. If any of the following are present, seek the advice of your Family Doctor or Paediatrician: if your child is particularly self-conscious, anxious, distressed or having difficulty functioning as a result of their tics. Sofronoff, K., Leslie, A., & Brown, W. (2004). Watching your child tic can feel overwhelming and frustrating. Roux, G., Sofronoff, K., & Sanders, M. (2013). The issues surrounding the complexity of diagnosis of tic disorders are well-documented (Robertson and Cavanna 2008) and divergence in professional opinion may reflect this wider debate. Three factors were extracted and rotated, accounting for 68 % of study variance. That’s why it’s important to not feel guilty and to share your feelings with loving/supportive people. The value of parenting interventions was therefore viewed as providing practical skills to parents, (s7:’Learning skills to develop a parent–child relationship through play, warmth, praise and attention is important in a parenting intervention for TSC’; +5), and (s6:‘Learning skills to manage children’s anxiety is important in a parenting intervention for TSC’; +4). Clinical Child and Family Psychology Review, All professionals agreed the importance of parenting practices on children’s well-being (e.g., Statement 50:‘Positive child-parent interactions are important for children’s adjustment and quality of life’; F1 = +4, F2 = +6, F3 = +4), and identified positive parenting skills as an intervention target (s8:‘Learning skills to give children positive attention, praise and rewards is important in a parenting intervention for TSC’; F1 = +3, F2 = +3, F3 = +4). Reducing problem behavior during care-giving in families of preschool-aged children with developmental disabilities. Parent management training and Asperger syndrome a randomized controlled trial to evaluate a parent based intervention. Factor interpretations are presented by reporting the relevant statement and associated factor ranking. “Often times, the biggest treatment of tics is reassurance to the child and family, in addition to providing education on when it is appropriate to suppress a tic or not. “When you draw attention to the tic, it can exacerbate the child’s anxiety, and anxiety can make tics worse.” Research into parenting interventions within this population is limited. 42, 370–1375. The intervention involved both youths and parents, with specific parent-training modules, and results showed positive impacts on child quality of life and tic impairment. This means that a child with simple childhood tic disorder can have repetitive eye blinking during one point in time, and during another phase, can have irregular but repetitive shoulder shrugging, and later, intermittent head twitching. Prevalence across tic disorders varies from 0.77 % for Tourette syndrome to 2.99 % for transient tic disorder (Knight et al. However, there are times when you have to hold your child to the same standard as anyone else. Combining parent and child training for young children with ADHD. Within a randomized controlled trial (RCT) design, only one study by Scahill et al. Professionals viewed parenting interventions as providing a reflective environment within which parents could explore and re-evaluate their cognitions to facilitate acceptance, adjustment and hope. Parenting a child with tics can feel overwhelming at times, especially while practicing #socialdistancing and #stayingathome. School of Psychological Sciences, University of Manchester, 2nd Floor Zochonis Building, Manchester, M13 9PL, UK, Gemma A. L. Evans, Anja Wittkowski, Hannah Butler & Penny Bunton, Evelina London Children’s Hospital, St Thomas’ Hospital, London, SE1 7EH, UK, You can also search for this author in Factor 1 ‘Reflecting, Accepting and Knowing’ particularly endorsed the importance of providing a reflective environment to facilitate parental acceptance, adjustment and hope, alongside providing specialist tic-related information. Exploration of professionals’ views during these early stages of treatment development and implementation has been achieved using a number of methods, including Q-methodology. Children who have Tourette syndrome usually have their worst symptoms when they are between 9 and 13 years old. They can be annoying. 2011). 2, 67–91. For example, one could assume that it is highly likely that a sample of child health care professionals will strongly endorse a statement such as s50:‘Positive child-parent interactions are important for children’s adjustment and quality of life’. A meta-analysis of behavioral parent training for children with attention deficit hyperactivity disorder. 123 Journal of Child and Family Studies ISSN 1062-1024 J Child Fam Stud DOI 10.1007/s10826-015-0317-1 Parenting Interventions for Children with Tic Disorders: Professionals’ Perspectives (2015) implemented a RCT of a modularized cognitive behavioural intervention termed ‘living with tics’. 2013; McIntyre 2008). The relative ranked positions reflect emergent viewpoints, permitting a reliable and quantifiable means of exploring participant opinion (Watts and Stenner 2012). Several professionals worked within specialist neuropsychiatry and tic disorder clinics and several held tic-related research roles. Tic Suppression in Children With Recent-Onset Tics Predicts 1-Year Tic Outcome. Surprisingly, intervention components directed at behavioural control were not strongly endorsed, despite the high co-morbidity and impact of behavioural difficulties on child and family functioning (Sukhodolsky et al. This study had full ethical approval. 2009) and attention deficit disorder (Azevedo et al. In terms of attendants, delivering parenting interventions regardless of tic severity and to parents-only was endorsed, consistent with the advocated focus on parental cognitions, (s55:‘Parenting interventions for TSC should only be offered to parents of children with more severe tics’;−4) and (72:‘Family members, friends, and teachers should be invited to attend parenting interventions for TSC’; −3). Furthermore, general parent training programmes such as the Incredible Years Programme (Webster-Stratton 2006) and Triple P (e.g., Sanders 1999) which also aim to provide techniques to promote positive parenting and child-parent interactions (e.g., play, quality time, limit setting, modelling, problem-solving) also provide skills advocated by the current study, and may thus offer some contribution to tic disorders. Tics provide immediate relief for a vexing physical sensation. (2008). Tic disorders and Tourette’s syndrome affect about 1 in 100 children. (2010) evaluated the use of a ‘comprehensive behavioural intervention for tics (CBIT)’ in a large RCT involving children and adolescents. All professionals endorsed a need and financial justification for tic-specific interventions (s28:‘Parents of children with and without TSC have similar needs so interventions just for children with TSC are unnecessary’; F1 = −4, F2 = −3, F3 = −4), and (s37:‘Parenting interventions for TSC are not a good use of NHS money’; F1 = −5, F2 = −4, F3 = −4). Limit the usage of wheat and dairy products that can increase tics in children. Google Scholar. 2003; Robertson and Cavanna 2008). Information to develop the Q-set was derived from various sources (Watts and Stenner 2012). Participants with experience of working professionally with tic disorders and/or delivering parenting interventions were included. Psychiatry Research, Many people with tics experience a physiological feeling that urges them to do the tic. Robertson, M., & Cavanna, A. Thus, establishing the potential intervention possibilities for parent-only interventions offers value. Indeed, these parent-based outcomes were endorsed over tic modification (s66:‘Changing children’s tics is an important outcome of parenting interventions for TSC’; −3). 2011). Indeed, the results may reflect the assumed current mindset of child health care professionals across many disorders, yet it is the first study to use such an approach in order to explore this mindset. The current lack of research was, however, identified as an obstacle to implementation (s61:‘The lack of research in parenting interventions for TSC is a barrier to treatment’; +3), perhaps given professionals increased familiarity with research evidence in tic disorders. The study also provides guidance around general intervention content, identifying important components as teaching positive parenting skills, addressing parental cognitions and providing techniques to manage children’s anxiety and social skills. Parent-based motivation or worry were not seen as barriers (s33: ‘Parents would not complete homework as part of a parenting intervention because they lack motivation’; F1 = −3, F2 = −3, F3 = −3) and (s19:‘Parents would be worried that changing parenting techniques would make things worse’; F1 = −2, F2 = −2, F3 = −2). Sharing information about a child’s tics with his teachers and friends can also be useful. Help your child participate in normal activities. European Child and Adolescent Psychiatry, With them, they’re likely to discover what is producing the nervous habit or tic. Even though he is expressing frustration, it is a good sign that your son is already talking to you about the behaviours, as … Randomized trial of parent management training in children with tic disorders and disruptive behavior. In 1978, while at a board meeting in her parent’s home, Mr. Bliss told Shari about his theory of premonitory urges and provided some tips and tricks on how to control the tics. (2015). The current study thus aimed to explore professionals’ views of parenting interventions within tic disorders using Q-methodology for the first time, with particular consideration to perceived acceptability, feasibility, effectiveness and utility. Please see the resource guide for referral sources. However, most professionals were from a clinical psychology background, possibly introducing some bias as a result of the over-representation of psychologists in recruitment sources. Whilst these interventions have been directed at parents, some studies have also evaluated treatment models in which adjunctive parent interventions are implemented alongside child-directed treatments (e.g., Autistic spectrum conditions: Sofronoff et al. Behaviour therapy for children with Tourette disorder: A randomized controlled trial. Children run the risk of burnout when they try too hard. Multidisciplinary professionals endorsed parenting interventions as a therapeutic tool within tic disorders. McGuire, J., Arnold, E., Park, J., Nadeau, J., Lewin, A., et al. The tics themselves can also change over time, says Dr. Mary Zupanc, chair of neurology and the director of CHOC Children’s pediatric comprehensive epilepsy program. Eight professionals loaded onto Factor 1, explaining 25 % of the variance. Surprisingly, whilst the majority of professionals indicated professional involvement with children with tic disorders and parents, only ten of the 25 professionals indicated frequent or very frequent professional experience of working with tic disorders. Family Process, One of the most recommended activities in these cases is for the children to learn relaxation and breathing techniques. Journal of the American Academy of Child and Adolescent Psychiatry, Behaviour Change, 2007). Attitudes of relatives and staff towards family interventions in forensic services using Q methodology. In terms of attendants, delivering parenting interventions regardless of tic severity and to parents-only was endorsed, consistent with the advocated focus on parental cognitions, (s55:‘Parenting interventions for TSC should only be offered to parents of children with more severe tics’;−4) and (72:‘Family members, friends, and teachers should be invited to attend parenting interventions for TSC’; …

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