The Tourette OCD Alberta Network: Development of a Continuing Professional Development Program for Community Based Mental Health Therapists.

The Tourette OCD Alberta Network (TOAN) supports mental health therapists to improve the delivery of care to patients with Tourette syndrome (TS) and OCD in Alberta. We evaluated the professional development needs of health care workers to develop a continuing professional development (CPD) webinar series. Health care workers demonstrated an urgent need to access a CPD program grounded in evidenced based knowledge about TS and OCD. While 80% of health care workers treated children with TS and OCD, 50% had no formal training. A curriculum consisting of a series of twelve live, online webinars was developed and delivered between September 2020 and June 2021, covering a range of clinical topics. The webinars were attended on average by 63 attendees, with the outcome of a positive knowledge gain. In future, the educational program will need to reflect the ongoing developing clinical understanding of TS and OCD.

Clinical Reasoning: A Missing Piece for Improving Evidence-Based Assessment in Psychology.

Clinical reasoning is a foundational component of conducting evidence-based psychological assessments. In spite of its importance, limited attention has been paid to the teaching or measurement of clinical reasoning skills relative to psychological assessment, as well as how clinical reasoning develops or how its efficacy can be measured. Improving clinical reasoning throughout the assessment process, from initial case conceptualization to hypotheses testing, to recommendation writing, has the potential to address commonly noted concerns regarding diagnostic accuracy, as well as the accessibility and utility of psychological reports and recommendations, and will, ultimately, lead to improved outcomes for clients. Consequently, we provide a definition of clinical reasoning in relation to psychological assessment, followed by a critique of graduate training assessment and the current challenges of measuring clinical reasoning in psychology. Lastly, this paper provides suggestions for how to incorporate clinical reasoning throughout the assessment process as a way to answer client questions more effectively and provide meaningful recommendations to improve outcomes.

Pediatric Co-Norms for Finger Tapping, Grip Strength, and Grooved Pegboard in a Community Sample.

OBJECTIVE: Motor tests, including Finger-Tapping Test, Grooved Pegboard Test, and Grip Strength Test, are frequently used by neuropsychologists when assessing pediatric populations. Many of the norms available for these measures are outdated, have not been co-normed, and have samples with limited diversity. This study aims to provide updated, co-norms for three commonly used motor tasks with a diverse population. METHOD: Participants (n = 476; age range 6-14) were recruited from community settings to complete each of the three motor tests. RESULTS: Results demonstrate generally improved performance across ages with no significant difference between performance of males and females on the Grooved Pegboard Test or the Finger Tapping Test. The only significant findings were on the Grip Strength Test where 12-14-year-old boys demonstrated stronger performance on the dominant hand. CONCLUSION: This study provides updated and co-normed data on frequently used motor tasks with a diverse pediatric sample, which are useful for clinicians.

Targeted Interventions in Tourette's using Advanced Neuroimaging and Stimulation (TITANS): study protocol for a double-blind, randomised controlled trial of transcranial magnetic stimulation (TMS) to the supplementary motor area in children with Tourette's syndrome.

INTRODUCTION: Tourette's syndrome (TS) affects approximately 1% of children. This study will determine the efficacy and safety of paired comprehensive behavioural intervention for tics (CBIT) plus repetitive transcranial magnetic stimulation (rTMS) treatment in children with Tourette's syndrome. We hypothesise that CBIT and active rTMS to the supplementary motor area (SMA) will (1) decrease tic severity, and (2) be associated with changes indicative of enhanced neuroplasticity (eg, changes in in vivo metabolite concentrations and TMS neurophysiology measures). METHODS AND ANALYSIS: This study will recruit 50 youth with TS, aged 6-18 for a phase II, double-blind, block randomised, sham-controlled trial comparing active rTMS plus CBIT to sham rTMS plus CBIT in a 1:1 ratio. The CBIT protocol is eight sessions over 10 weeks, once a week for 6 weeks and then biweekly. The rTMS protocol is 20 sessions of functional MRI-guided, low-frequency (1 Hz) rTMS targeted to the bilateral SMA over 5 weeks (weeks 2-6). MRI, clinical and motor assessments and neurophysiological evaluations including motor mapping will be performed 1 week before CBIT start, 1 week after rTMS treatment and 1 week after CBIT completion. The primary outcome measure is Tourette's symptom change from baseline to post-CBIT treatment, as measured by the Yale Global Tic Severity Scale. Secondary outcomes include changes in imaging, neurophysiological and behavioural markers. ETHICS AND DISSEMINATION: Ethical approval by the Conjoint Health Research Ethics Board (REB18-0220). The results of this study will be published in peer-reviewed scientific journals, on ClinicalTrials.gov and shared with the Tourette and OCD Alberta Network. The results will also be disseminated through the Alberta Addictions and Mental Health Research Hub. TRIAL REGISTRATION: NCT03844919.

Developing a provincial patient support network for children and families affected by Tourette syndrome and/or obsessive-compulsive disorder: results of a stakeholder consultation.

BACKGROUND: Tourette syndrome and OCD are disorders that frequently occur in children and cause a high level of disability. In Alberta there is a huge delivery gap in providing healthcare services for children with TS and OCD. A stakeholder consultation was performed to ascertain how service delivery could be improved across the province and to inform the development of a provincial information and support organization, the Tourette OCD Alberta Network. METHODS: A mixed-methods study was employed: 10 parents were recruited for interview and 140 parents responded to a survey. RESULTS: Qualitative data showed there was often an absence of a clear pathway to access healthcare for people with TS and OCD. The negative impact of not receiving treatment, information, and resources in a timely and prompt manner was also revealed. Good clinical practice existed across the province but too often it was hindered by a shortage of knowledge about TS and OCD. In schools, learning for students with TS and OCD was also impaired by educators' lack of knowledge and preparedness in relation to the disorders. CONCLUSIONS: This study identified ways that challenges with healthcare access, school learning, and seeking information can be overcome. Skills-based training webinars, educational outreach in schools, and peer support were recognized as actions for improving healthcare outcomes for people with TS and OCD. The aim of the Tourette OCD Alberta Network is to provide services and support that directly address the healthcare service delivery shortfalls shown in this study.

Executive Functioning in Youth With and Without Chronic Pain: A Comparative Analysis.

OBJECTIVES: Preliminary research in youth with chronic pain suggests differences in attention and working memory, which has been similarly demonstrated in adults with chronic pain. There has been little research on other aspects of executive functioning (EF) in this population despite its critical role in problem solving, school functioning, and coping. This study aimed to examine differences in several aspects of EF between youth with chronic pain and a nonchronic pain comparison group using performance-based neuropsychological tests and a behavior rating scale. MATERIALS AND METHODS: Participants completed ratings of pain; physical, emotional, social, and school functioning; sleep quality; medication; and a general intelligence screener. Standardized neuropsychological tests were used to examine EF with a focus on working memory, divided and alternating attention, inhibition, flexibility, incidental memory, and planning. A parent-report and self-report behavior rating of EF was also administered. RESULTS: Recruitment from 2 tertiary-care pain clinics resulted in a sample of 26 youth with chronic pain (80.8% girls) and their parents. A comparison group of 30 youth without chronic pain and their parents were recruited from the community. Participants with chronic pain had significantly lower scores on several performance-based tests of working memory/divided attention, inhibition, and flexibility/alternating attention than the comparison group. Statistically significant group differences were also found on behavior ratings of emotion control, shifting, task initiation and completion, working memory, planning and organization, overall emotion and cognitive regulation as well as global EF. Covariate analysis was conducted in all analyses where there were significant group differences and several observed group differences remained. DISCUSSION: This study is one of few multidimensional examinations of EF in youth with chronic pain, using a comprehensive neuropsychological test battery combined with behavior ratings. Our findings suggest EF differences in youth with chronic pain, across a variety of domains and may suggest risk for specific cognitive processing weaknesses in this population. Medical and educational teams should work toward identification, treatment, and compensatory support for EF within individualized pain management for youth.

Management of haemorrhage and haemorrhagic shock.

Haemorrhage is defined as the acute loss of blood from the circulating volume, while haemorrhagic shock is characterised by suboptimal perfusion caused by bleeding. Their prompt recognition and management is vital to ensure optimal outcomes. This article discusses the assessment and management of patients experiencing haemorrhage and developing haemorrhagic shock. It also outlines how these conditions are classified, and explains their pathophysiology. The article emphasises the importance of a thorough ABCDE (airway, breathing, circulation, disability, exposure) assessment and prompt identification of the source of bleeding, along with the initial management of a patient who is bleeding.

Why Educational Neuroscience Needs Educational and School Psychology to Effectively Translate Neuroscience to Educational Practice.

The emerging discipline of educational neuroscience stands at a crossroads between those who see great promise in integrating neuroscience and education and those who see the disciplinary divide as insurmountable. However, such tension is at least partly due to the hitherto predominance of philosophy and theory over the establishment of concrete mechanisms and agents of change. If educational neuroscience is to move forward and emerge as a distinct discipline in its own right, the traditional boundaries and methods must be bridged, and an infrastructure must be in place that allows for collaborative and productive exchange. In the present paper, we argue that school psychologists have the potential to fulfill this need and represent important agents of change in establishing better connections between research and practice. More specifically, we use the National Association of School Psychologists (NASP) (2020) Domains of Practice to highlight several areas where school psychology can actively support forging connections between neuroscience and educational practice. School psychologists represent untapped potential in their knowledge, skillset, and placement to serve a vital role in building the bridge between neuroscience and education.

Nursing patients with acute aortic dissection in emergency departments.

Acute aortic dissection is an emergency condition that is often missed during initial assessment. Delay in diagnosis increases mortality, but the presentation can mimic several more common conditions. Emergency practitioners must maintain a high index of suspicion in patients who present with chest or back pain and ensure timely diagnostic testing and interpretation of results if aortic dissection is suspected.

The 'work of childhood': understanding school functioning in youth with chronic pain.

School is often cited as the 'work of childhood' and serves as an important site for child and adolescent development. Frequent school absences in children and adolescents with chronic pain are well documented; however, variables that may explain school impairment are not understood. The potential consequences of school impairment are extensive, as these children and adolescents are at great risk for achieving poor grades and sometimes require full-time homebound instruction. This, in turn, can have adverse effects on occupational and social functioning well into adulthood. The present review provides a summary of selected studies that have investigated why children and adolescents with chronic pain may experience disruptions in school functioning. A conceptual model of school functioning is presented to summarize factors accumulated to date and to guide future investigations.

Reconsidering "inattention" in attention-deficit hyperactivity disorder: implications for neuropsychological assessment and intervention.

Attention-deficit hyperactivity disorder (ADHD) does not exist. This explicit statement needs elucidation of course given ADHD is a common neurodevelopmental disorder, but it provides the reader with the impetus to reconsider long-held beliefs about this condition and its treatment. Surely, there is a disorder called ADHD from which this thesis is framed, but primary attention and hyperactivity-impulsivity problems are mediated by different albeit interrelated brain systems. Like many neurodevelopmental disorders (e.g., learning disabilities, autism spectrum disorder), the medical and psychological professions have used a single, large inclusive ADHD diagnostic category to represent children with different etiologies for their overt symptoms. Despite neurobiological differences among children diagnosed with ADHD, the clinical position that attention-deficit or primary attention problems are sufficient for ADHD identification undermines clinical practice. This commonly accepted dubious position not only undermines the diagnostic utility of our neuropsychological measures, but it attenuates treatment effects as well. Supported with evidence from our ongoing ADHD research program, this data-based review will support these contentions and provide implications for diagnosis and treatment of children with attention problems.

Psychosocial and Adaptive Deficits Associated With Learning Disability Subtypes.

Children with specific learning disabilities (SLD) have deficits in the basic psychological processes that interfere with learning and academic achievement, and for some SLD subtypes, these deficits can also lead to emotional and/or behavior problems. This study examined psychosocial functioning in 123 students, aged 6 to 11, who underwent comprehensive evaluations for learning and/or behavior problems in two Pacific Northwest school districts. Using concordance-discordance model (C-DM) processing strengths and weaknesses SLD identification criteria, results revealed working memory SLD (n = 20), processing speed SLD (n = 30), executive SLD (n = 32), and no disability groups (n = 41). Of the SLD subtypes, repeated measures MANOVA results revealed the processing speed SLD subtype exhibited the greatest psychosocial and adaptive impairment according to teacher behavior ratings. Findings suggest processing speed deficits may be behind the cognitive and psychosocial disturbances found in what has been termed "nonverbal" SLD. Limitations, implications, and future research needs are addressed.

The effects of methylphenidate on cognitive function in children with attention-deficit/hyperactivity disorder.

Focusing on behavioral criteria for attention-deficit/hyperactivity disorder (ADHD) diagnosis leads to considerable neuropsychological profile heterogeneity among diagnosed children, as well as variable response to methylphenidate (MPH) treatment. Documenting "cold" executive working memory (EWM) or "hot" self-regulation (SR) neuropsychological impairments could aid in the differential diagnosis of ADHD subtypes and may help to determine the optimal MPH treatment dose. In this study, children with ADHD inattentive type (n = 19), combined type (n = 33), and hyperactive-impulse type (n = 4) underwent randomized controlled MPH trials; neuropsychological, behavioral, and observational data were collected to evaluate the children's responses. Those with moderate or significant baseline EWM/SR impairment showed robust MPH response, whereas response for those with lower baseline impairment was equivocal. Implications for medication use and titration, academic achievement, and long-term treatment efficacy are examined.