Chronic Tic Disorder, including Tourette Syndrome, (CTD) is a relatively common and typically impairingneurodevelopmental disorder of childhood. CTD is associated with deficits in cogntive control, includingworking memory and response inhibition, and dysfunction of cortico-striatal circuits. Although medicationstargeting 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 seriousside effects associated with pharmacotherapy. This project aims to clarify the functionalanatomy of key circuits subserving cognitive control in youngsters with CTD, to examine hypothesizedmechanisms of cognitive enhancement associated with HRT, and to compare these mechanisms to thoseidentified for medication treatment of ADHD. Determining the neural basis of behavioralinterventions, such as HRT, and establishing the generalizability of these findings, has the potential tosignificantly enhance development of improved treatment strategies for CTD, including the development ofoptimal treatment regimes for individual patients. As such, the aims are highly consistent withthe overal goals of the CIDAR. A total of 60 youngsters (aged 7-16) with a DSM-IV Chronic Tic Disorder willreceive eight weeks of HRT using a manualized treatment protocol developed and previously tested by ourgroup. Youngsters will also undergo comprehensive clinical, cognitive/EEG, and fMRI evaluation at baselineand post-treatment. A reduced clinical and cognitive/EEG battery will also be collected mid-treatment andthree month follow-up (responders only) to examine course and durability of response. All participants will be initially recruited and screened by theResearch Assessment Unit (RAU) which will also recruit a matched sample of normal controls to allow forbaseline clinical, EEG/fMRI comparison with the CTD and Project III ADHD patient samples. The fMRI andEEG/Cognitive components of the study will be executed through close collaboration with the Imaging andResearch Methods (RMC) Cores, respectively. Finally, treatment-related findings from this project will besystematically compared to those from Project III in order to document the potential commonality of neuralmechanisms of treatment response across multiple disorders and treatment modalities.
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