title: Patterned changes in urge ratings with tic suppression in youth with chronic tic disorders.
abstract: BACKGROUND
  Premonitory urges are central to emerging behavioral models of chronic tic disorders (CTD). Urge reduction has been proposed as a behavioral explanation for tic maintenance and exacerbation as well as the efficacy of behavioral treatments. Prior investigations have produced inconsistent findings despite common methodologies. The current study evaluated the possibility that data aggregation obscures distinct and meaningful patterns of change in urge ratings when tics are freely expressed versus suppressed.
  
  
  METHODS
  Participants (n = 12) included children with moderate-to-marked tic severity and noticeable premonitory urges. Tic frequencies and urge ratings were obtained at 15 s and 10-s intervals, respectively, across an alternating sequence of 10-min tic freely and 40-min tic suppression conditions. Patterns were established using a two step approach.
  
  
  RESULTS
  Five distinct patterns of urge rating change emerged, suggesting data aggregation may obscure meaningful patterns in the urge-tic relationship when tics are completed versus suppressed.
  
  
  CONCLUSIONS
  Eligibility criteria may have unintentionally excluded younger affected children and included older participants with more severe tic disorders than commonly seen. Additional research with less stringent eligibility criteria and a larger sample size will help validate the results.
  
  
  CONCLUSIONS
  The relationship between urges and tics is much more complex than previously theorized. Investigations that rely on global assessments of urge and tic severity and/or assume uniformity when aggregating participant data may obscure meaningful differences in the urge-tic relationship. Future investigations should examine the possibility that individual differences and/or developmental considerations modulate the functional urge-tic relationship.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Bloomberg Children's Center, Level 12, Johns Hopkins Hospital, 1800 Orleans Street, Baltimore, MD, 21283, USA.
authors.forename: Laurel A
authors.initials: LA
authors.lastname: Brabson
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Bloomberg Children's Center, Level 12, Johns Hopkins Hospital, 1800 Orleans Street, Baltimore, MD, 21283, USA.
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Brown
authors.affiliation: Department of Psychology, University of Wisconsin-Milwaukee, 224 Garland Hall, 2441 E. Hartford Ave., Milwaukee, WI, 53211, USA; Department of Psychiatry, University of California San Francisco, 401 Parnassus Ave., San Francisco, CA, 94143, USA.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Capriotti
authors.affiliation: Department of Psychology, University of Utah, 380 S. 1530 E, Rm 502, Salt Lake City, UT, 84112, USA.
authors.forename: Krishnapriya
authors.initials: K
authors.lastname: Ramanujam
authors.affiliation: Department of Psychology, University of Utah, 380 S. 1530 E, Rm 502, Salt Lake City, UT, 84112, USA.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Himle
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Bloomberg Children's Center, Level 12, Johns Hopkins Hospital, 1800 Orleans Street, Baltimore, MD, 21283, USA.
authors.forename: Cassandra M
authors.initials: CM
authors.lastname: Nicotra
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Bloomberg Children's Center, Level 12, Johns Hopkins Hospital, 1800 Orleans Street, Baltimore, MD, 21283, USA.
authors.forename: Rick
authors.initials: R
authors.lastname: Ostrander
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Bloomberg Children's Center, Level 12, Johns Hopkins Hospital, 1800 Orleans Street, Baltimore, MD, 21283, USA.
authors.forename: Laura M
authors.initials: LM
authors.lastname: Kelly
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Bloomberg Children's Center, Level 12, Johns Hopkins Hospital, 1800 Orleans Street, Baltimore, MD, 21283, USA.
authors.forename: Marco A
authors.initials: MA
authors.lastname: Grados
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Bloomberg Children's Center, Level 12, Johns Hopkins Hospital, 1800 Orleans Street, Baltimore, MD, 21283, USA.
authors.forename: John T
authors.initials: JT
authors.lastname: Walkup
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Bloomberg Children's Center, Level 12, Johns Hopkins Hospital, 1800 Orleans Street, Baltimore, MD, 21283, USA.
authors.forename: Carisa
authors.initials: C
authors.lastname: Perry-Parrish
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Bloomberg Children's Center, Level 12, Johns Hopkins Hospital, 1800 Orleans Street, Baltimore, MD, 21283, USA.
authors.forename: Elizabeth K
authors.initials: EK
authors.lastname: Reynolds
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Bloomberg Children's Center, Level 12, Johns Hopkins Hospital, 1800 Orleans Street, Baltimore, MD, 21283, USA.
authors.forename: Jessica C
authors.initials: JC
authors.lastname: Hankinson
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Bloomberg Children's Center, Level 12, Johns Hopkins Hospital, 1800 Orleans Street, Baltimore, MD, 21283, USA. Electronic address: mspecht1@jhmi.edu.
authors.forename: Matt W
authors.initials: MW
authors.lastname: Specht
mesh_terms: D000293:Adolescent; D002648:Child; D002908:Chronic Disease / Q000523:psychology; D005260:Female; D006801:Humans; D007266:Inhibition, Psychological; D008297:Male; D013981:Tic Disorders / Q000175:diagnosis* / Q000523:psychology*
keywords: Negative reinforcement; Tic suppression; Tourette's; Urge