Cognitive enhancements and mental conditions #1: the “negative medical bias problem”.

I was going to extend that post on emotions and omotions into a post on racial pejoratives and sensitivity to the term “privilege”, but I need to think about some [a] resources [b] that Tony at The Shoop’s Roost gave me. Bigotry and how all of the little pieces that create it is a pretty complex thing and that bears some thinking about. So I’m going to put that one on hold for a bit and finally start a series of posts about alterations in how the minds of people with Tourette’s Syndrome can be benefits and not just the drawbacks that we all hear about through medicine and popular culture. This series is meant to eventually be turned into a presentation that I can give to children and adults with TS so that they can get a better idea about what TS is (as best as we can understand it) and how they might use it to their benefit.

[Lets just get it over with.

We believe that Tourette’s Syndrome, AD(H)D, OCD, Autism, Schizophrenia and some other mental conditions are “features” of humanity and not “bugs”. THEY ARE NORMAL AND NATURAL as a general rule, though they can be debilitating at their most intense because human development is not a clean process. The problem is that in a modern context things are a lot more confusing and we have culturally decided to pretend that we are all the same (for good reasons that have bad effects). So as medical research started pinching off groups of humans as having similar sets of features, we have been resistant to the idea that these people who have mental strengths and interesting relationships with the surrounding society are in fact how we sort into “kinds” of humans.

Now to start demonstrating it.]

History and the negative bias problem.

As a species we do some things pretty good, and we do some things pretty badly. We are pretty good at identifying and understanding things that cause people suffering when it comes to medicine and creating systems to try to deal with that suffering. Modern medicine is fantastic in how it’s able to take a human problem and figure out what is happening at multiple levels from the molecular to the social. We have tremendous knowledge about what is wrong. So much knowledge that a major part of science is creating ways of organizing and using all of that knowledge constructively. But we can also be very foolish as a species because of how our minds work in a modern social context.

[A little knowledge can be a dangerous thing, especially when we don’t always do the best thing or the right thing with that knowledge because we are social primates with an evolutionary history very different from the world we live in today. We are in many ways a reminder of what things were like so when you react or act you are often pretending that it’s 500,000 years ago and have no idea.]

We tend to have a negative emotional bias as a species [1] meaning that on average we will pay more attention to the negative. Bias [2] is a word that I’m sure that many of you have heard before. I’m also willing to bet that you have heard that bias is a bad thing as “being biased” is used to dismiss people in arguments often. But it’s not a bad thing, it is in fact a neutral thing since bias just means that your reasoning and motivation is shaped towards particular things. If you have personal experience with evidence that pushes you towards one side of a social conflict (for example you have studied the evidence for biological evolution) you are in fact biased on that issue for good reasons. Bias means you are not neutral with respect to something independent of anything else, and the reason bias tends to be a negative word is because we are not naturally neutral without culture.

Negativity Bias

 

I think that what this means functionally is that on average when encountering things we don’t personally have experience with we will be cautious and suspicious. Think about it like this, would it be better for your ancestors to see lions in bushes where there were none (false positive error [3]), or to miss the lion that was there (false negative error [4])? Your ancestors would have had a greater chance of surviving if they saw the occasional thing that was not there. So up here in modern times it’s likely the case that we prioritize negative emotions as higher than positive ones. So we emphasize negative characteristics and possible harms more than positive characteristics and possible benefits when thinking about or perceiving things we do not have personal experience with.

[We can’t say if this bias is “hardwired” or not, or how pervasive it is in how we perceive the world. It’s possible that humans would be neutral towards unfamiliar things if it were not for the effect of culture on how we interact with the world. But I would say that functionally we have a negative bias towards things called mental conditions.]

[This is balanced by some positive biases such as an in-group bias that flips this to a positive emotional bias with respect to people and things we have personal experience with. That whole “seeing patterns where there are none” might explain conspiracy theorists. There is probably more that one of those with TS, not to mention a bunch of mad prophets.]

As each of our individual emotional impressions diffuses into the nested sets of organized groups that make up society through of our personal interactions the emotional impressions become “averaged”* into our shared morals, ethics, assumptions, emotional sensitivities, group narratives and more about the things we care about the most. Consider the emotional priorities of Democrats or Republicans versus the emotional priorities of America as a whole, and the collection of stories each group tells.

[*Averaging is not a simple as the average of 5, 5, and 5 being 7.5. That average is altered by the fact that we will be more or less sensitive to things depending on what the emotion is, what object it’s attached to, what our experience of that object was and how significant (intensity of benefit/harm/previous experience/peer opinion/…) the object is to us. A good general picture of a way the average is biased is represented by Maslow’s Hierarchy of Needs [5]. For example the more personal and related to resource acquisition something is, the more intensely you will tend to feel about it.]

How the negative emotional bias relates to what is called “mental illness”, “mental disorder” or the most neutral one I could think of “mental condition” has to do with how medicine handles suffering people and history.

 

Perception of medicine associated things shaped by the negative emotional bias and history.

Medicine is in the business of ending suffering, as it should be. Some of that suffering runs so deep that rationality becomes challenging or impossible while experiencing, interacting with and remembering. So it is totally reasonable that a whole lot of negative emotion be bound up in medicine when it comes to medical problems and the social structure that researches and delivers solutions to suffering. But as I pointed out above we tend to prioritize the negative in perception thought and memory. So we will tend to understand things associated with medicine by negative emotional impressions more often.

Where we start running into problems is in the reality of how an “illness”, “disorder” or “condition” is defined.

[Since some of you might sense me getting evasive, equivocal and hair-splitty, no matter what the objective reality of diseases, disorders and conditions is the priority is ending suffering. We are not dismissing or ignoring anyone’s experience of a mental illness, mental disorder or mental condition. We are unapologetic in pointing out that a lot of what we act like we want to eradicate is very likely to be “features” of what humanity is and not “bugs”. Perfectly natural ways that brains and minds operate that can be expressed in ways and contexts that can cause suffering to a the person with the thing, or someone else who they affect. In this case I think that society just does not know what to do with us now that we no longer live in groups of 150.]

Let’s start out “easy”. Is aggression or assertiveness and objectively bad thing? No. There are times when one should be aggressive or assertive, but if a person is aggressive or assertive in the wrong context (defined by experience + instinct + emotion + socialization > morality and ethics) they will harm someone or dominate someone for no good reason. Is seeking sex an objectively bad thing? No. But given the statistics on rape there is a lot of sex seeking going on in a context that causes suffering. Now think about how people bias their emotions with respect to medicine and aggression, assertiveness and sex. That is a metric fuckton of current controversies and I don’t think it will take you long to think of an example. The same is true of many things we call mental illnesses/disorders/conditions and the ones relevant to people like me are the neurodevelopmental disorders [6]. (Wikipedia neurodevelopmental disorders [7])

The DSM-V lists many neurodevelopmental disorders but I want to focus on: Autism Spectrum Disorder, Attention-Deficit/Hyperactivity Disorder and Tourette’s Disorder. Now about 3% of the population is on the autism spectrum, 5% is on the AD(H)D and spectrum and 1% is on the TS spectrum. Those are not mutually exclusive so lets pretend that is 6% of the population. If these were like aggression, assertiveness and seeking sex we would expect to find situations where these features were a benefit instead of a drawback. Good instead of bad. It turns out that there are benefits.

Benefits of Autism, AD(H)D and Tourette’s Syndrome.

Autism.

It turns out that when you ignore the fact that medicine stereotypically only sees people complaining of suffering and you look at lots of the people in each of these groups, you start to see people actively benefiting from the characteristics that come with these conditions. Autism and TS share a lot of features. Both of us have sensory hypersensitivity [8] (which is associated with savant syndrome[9]).

[I’m not saying I am a savant, that’s the sort of thing other people say you are. I KNOW we are an arrogant sort. That being said what a savant is can inform about how perception can be shaped. If there is a “tourettic savant” knowing what parts of perception they were gifted in would be informative for how the tendencies are shaped in the rest of us.]

Both of us have rule-based language enhancements [10] (TS linked towards the end). Both of us have obsessions and compulsions that seem associated with organization and relationships (autism, [11] TS [12] and also [13]) and is in turn related to what is called called hypersystematic behaviors and tendencies in autism. Lately people with autism who have benefited from the features of autism have been getting a lot more press and there are even business opportunities in placing people with autism in jobs that benefit from their natural talents [14]. The benefits of being a person with autism seem to be related to classes or categories of objects, how they are organized and what they associated details are. For example:

…computers, trains, historical dates or events, science, or particular TV programmes. Many younger children with autism like Thomas the Tank Engine, dinosaurs or particular cartoon characters. Sometimes, people develop obsessions with things like car registration numbers, bus or train timetables, postcodes, traffic lights, numbers, shapes or body parts such as feet or elbows.

People with autism may also become attached to objects (or parts of objects), such as toys, figurines or model cars – or more unusual objects like milk bottle tops, stones or shoes. An interest in collecting is also quite common: it might be Star Trek DVDs, travel brochures, insects, leaves or bus tickets.

 

It’s like they are able to fixate on an object class like “television program” or “car associated number” and master what it is. I have to point out what I have read indicates that only some people with autism seem to have these abilities. But…

[…we think all people with autism have these abilities. What matters is if the had a life experience and made choices that let them build on them in ways that are useful to them. Did they have a life that let them learn to control the sensory torrent in a way that strengthened their ability to use the associated brain systems in contexts that benefit them.]

AD(H)D (Attention Deficit/Hyperactivity Disorder).

In AD(H)D the benefits are harder to describe because they are very qualitative. The “H” that can be dropped in and out has to do with the “hyperactivity component”.

[The difference between ADHD and ADD seems of a similar kind as the difference between an extrovert and an introvert and includes something called “externalizing behaviors”. We happen to hypothetically believe that analogously autism and TS are internalized and externalized versions of one another.]

ADD by itself has to do with a disengagement with the world because some “filters” that people use to detect, recall, store and retrieve information about reality. Those filters essentially “perk you up” and make reality interesting because the signals stand out and create interest. Without the emotional information in those filters we essentially become “bored” on a level that is extremely hard to deal with. That level of boredom is so bad that AD(H)D is associated with self-medicating “novelty-seeking behaviors” and we are more prone to substance abuse problems [15].

[This might help explain why we like arguing online.]

Without those filters we have more reading problems, tend to have less working memory for names and numbers and are not the best “paper work types”. The hyperactivity component makes you more interactive with the world so instead of the student that stares out the window we are the student that blurts out things without thinking. In the support groups we have to make sure we don’t neglect the people with ADD.

What about benefits [16]? The hyperactivity can be like having lots of energy if we focus it right. What about the filters? Without those filters it can be said that “reality does not grab us as strongly”. Sure we may annoy a person obsessed with order and structure (and can actually become one of those people) but think about what it means to “think outside of the box”. I think of that process as “pattern breaking” and we are really good pattern breakers, even when we don’t want to be. Here is something you may have encountered in school called a concept map.

Concept Map

In a concept that you take a central thing as an object (which can also be a concept) and you try to connect it to the concepts or features that the central object is most closely connected to (concepts the object consists of really). Like how a door is connected to the idea of going in and out, opening and closing, reversibly blocking an opening, security and other things. One reason we are so easily distracted is because those related concepts (and objects connected to them) are just as interesting to us as the central object. So our attention slides around all of the equally interesting things and right out of the box.  I also think of this as “tangential thinking”.

[See what I mean by context sensitive? You have to pair this with some solid skills in creating routines and organizing your life because where other people get unconscious help directing their attention we either have to have really good habits so we make sure we do what we need to do, or we develop really good concentration abilities so we can control as much of perception as we can.]

If we are really enjoying what we are doing we slip into a state called “hyper-focus” [17] where we can hold one part of something more complex in our attention so strongly that we don’t hear you trying to talk to us. Gamers have called this being in “the zone” and it’s a state everyone wants in a professional context. That last link also has some interesting stuff on day dreaming and creativity as well as leadership skills.

[But you have to learn to control that too because if we focus on something too hard we will fail to notice that something important is related to it, or something that we should do with it. Going down the wrong path and wasting time and effort because we chased the wrong thing sucks. If you are practiced you can eventually scan things and spot most important things most efficiently.]

As a result of this AD(H)D is often related to creativity and many of us are artists. The features are also good for a person in the position of being “on point” in a military formation since they must constantly scan for threats and objectives in a tense environment. I often wonder just how many of us manage to make it in the world of science though.

Tourette’s Syndrome.

Now we get to the one the blog is mostly about. The media has not caught up with TS advantages in the same way that it has with autism in that the cognitive (mental) advantages of autism are discussed and in TS it’s mostly the physical advantages that are discussed. For example soccer goalie Tim Howard attributes some of his success to TS [17]. I suppose that makes sense since after the verbal tics TS is best known for the physical tics and any article that gives people with TS some benefits with the physical aspects is a valuable thing.

But I want to take a deeper and more fundamental look at what TS is doing to our minds and not just at how the physical is changed. It’s the attempt to understand the cognitive advantages that has kept me obsessed and provided me some emotional drive after I had to leave my science career five years ago. More than anything else it was the following papers and the story of Dr. Samuel Johnson [19] that captured my imagination and pushed me towards teaching myself brain science.

In a series of posts I will be individually presenting the contents of these papers in a form that I hope to be able to directly turn into a PowerPoint presentation, right after a post that discusses what “rules” and “associations” mean when it comes to a major division in brain systems. Don’t worry about understanding all of the information in the abstracts below, I will do that in the next four posts. For now I have bolded the bits having to do with the enhancements in TS. As I go through them I will try to paint a picture of what the associated brain anatomy and systems are thought to do in general human terms. I will also try to describe just what I thing TS is as a “thing” that applies to all of us.

[We ask ourselves, what is a “tourettic savant”? And how do they appreciate the world in greater resolution and detail the way that an autistic savant does? We provide a “translation” of each abstract blow it.]

Time processing in children with Tourette’s syndrome [20]

BACKGROUND:
Tourette syndrome (TS) is characterized by dysfunctional connectivity between prefrontal cortex and sub-cortical structures, and altered meso-cortical and/or meso-striatal dopamine release. Since time processing is also regulated by fronto-striatal circuits and modulated by dopaminergic transmission, we hypothesized that time processing is abnormal in TS.

METHODS:
We compared time processing abilities between nine children with TS-only (i.e. without major psychiatric comorbidities) and 10 age-matched healthy children, employing a time reproduction task in which subjects actively reproduce different temporal intervals, and a time comparison task in which subjects judge whether a test interval is longer or shorter than a reference interval. IQ, sustained and divided attention, and working memory were assessed in both groups using the Leiter International Performance Scale-Revised, and the Digit Span sub-test of the WISC-R.

RESULTS:
Children with TS-only reproduced in an overestimated fashion over-second, but not sub-second, time intervals. The precision of over-second intervals reproduction correlated with tic severity, in that the lower the tic severity, the closer the reproduction of over-second time intervals to their real duration. Time reproduction performance did not significantly correlate with IQ, attention and working memory measures in both groups. No differences between groups were documented in the time comparison task.

CONCLUSIONS:
The improvement of time processing in children with TS-only seems specific for the over-second range of intervals, consistent with an enhancement in the ‘cognitively controlled’ timing system, which mainly processes longer duration intervals, and depends upon dysfunctional connectivity between the basal ganglia and the dorso-lateral prefrontal cortex. The absence of between-group differences on time comparison, moreover, suggests that TS patients manifest a selective improvement of ‘motor’ timing abilities, rather than of perceptual time abilities. Our data also support an enhancement of cognitive control processes in TS children, probably facilitated by effortful tic suppression.

 [TS involves alterations to brain anatomy and physiology that are known to be involved in the processing of the sense of time. Researchers compared nine children with TS-only and ten similar “normal” children in the ability to estimate and reproduce subsecond (less than one second) and suprasecond (greater than one second) lengths of time. TS children reproduced suprasecond lengths of time with greater accuracy than controls suggesting enhancement of “motor timing” systems.]

Smooth Pursuit and Fixation Ability in Children With Tourette Syndrome [21]

OBJECTIVE:
The smooth pursuit eye movements and fixation ability of children aged 8 to 16 years with Tourette syndrome (TS) were examined.

BACKGROUND:
Although several studies have examined the saccadic ability of patients with TS, there have been only a few studies examining pursuit ability in TS.

METHOD:
Pursuit gain (eye velocity/target velocity) and intrusive saccades during fixation were measured in children with TS-only, TS+attention deficit hyperactivity disorder (ADHD), and TS+ADHD+obsessive compulsive disorder (OCD), and in controls (8 to 16 y). Two pursuit tasks and 1 fixation task were used. In random pursuit 1 (RP1), each step and ramp cycle began from fixation; in random pursuit 2 (RP2), each cycle followed the next. In the fixation task, children were required to maintain fixation on a center dot and ignore distractor stimuli.

RESULTS:
All children had significantly higher pursuit gains in RP2 than in RP1 when pursuing a 30 degrees/s moving target. In addition, in RP2, the TS+ADHD+OCD group displayed significantly higher pursuit gains relative to the TS-only, TS+ADHD, and control groups. In the fixation task, the TS+ADHD group exhibited significantly more intrusive saccades than the TS+ADHD+OCD and control groups.

CONCLUSIONS:
Our findings support an enhanced oculomotor ability in the TS+ADHD+OCD group and the presence of an online gain control mechanism during ongoing pursuit. These findings are discussed in more detail.

[Now it gets trickier, some of these effects only show up when TS is combined with ADHD and OCD. I love biology…(no really)]

 [In an experiment designed to track how subjects were able to visually fix on and track targets, subjects with TS, ADHD and OCD were able to visually track targets with greater accuracy (defined as eye following target as it moves, “pursuit velocity gain”.]

Enhanced antisaccade abilities in children with Tourette syndrome: the Gap-effect Reversal [22]

Tourette Syndrome (TS) is a childhood onset disorder of motor and vocal tics. The neural networks underlying TS overlap with those of saccade eye movements. Thus, deviations on saccadic tasks can provide important information about psychopathology of TS. Tourette syndrome often coexists with Attention Deficit Hyperactivity Disorder (ADHD) and Obsessive Compulsive Disorder (OCD). Hence, we manipulated various components of a saccade task to measure its effects on saccades of children with TS-only, TS+ADHD, TS+ADHD+OCD and healthy controls. Children looked toward (prosaccade) or in the opposite direction (antisaccade) of a peripheral target as soon as it appeared. The prosaccade and antisaccade tasks were presented in three conditions. In the Gap200 condition, the fixation dot disappeared 200 ms prior to the appearance of the peripheral target, In the Gap800 condition, the fixation dot disappeared 800 ms prior to the appearance of the peripheral target and in Overlap200 the fixation dot disappeared 200 ms after the appearance of the peripheral target. Fixation-offset manipulations had different effects on each group’s antisaccades. The TS+ADHD+OCD group’s antisaccade latencies and error rates remained relatively unchanged in the three conditions and displayed a pattern of eye movements that can be interpreted as enhanced. Alternatively, the TS+ADHD group displayed an overall pattern of longer saccadic latencies. Findings corroborate the hypothesis that the combination of tic disorder and ADHD results in unique behavioral profiles. It is plausible that a subgroup of children with TS develop an adaptive ability to control their tics which generalizes to enhanced volitional control of saccadic behavior as well. Supporting evidence and other findings are discussed.

 [In an experiment designed to track how subjects were able to visually fix on and track targets, subjects with TS, ADHD and OCD were able to generate antisaccades (looking away from a peripheral target) at the same error rate (errors are looking in the wrong direction) in all trials. All other groups had error rates that increased as the time a central target was left behind before a peripheral target appeared increased. (The central target seems to interfere with locking onto the peripheral target).]

Speeded processing if grammar and tool knowledge in Tourette’s syndrome [23]

 Tourette’s syndrome (TS) is a developmental disorder characterized by motor and verbal tics. The tics, which are fast and involuntary, result from frontal/basal-ganglia abnormalities that lead to unsuppressed behaviors. Language has not been carefully examined in TS. We tested the processing of two basic aspects of language: idiosyncratic and rule-governed linguistic knowledge. Evidence suggests that idiosyncratic knowledge (e.g., in irregular past tense formation; bring-brought) is stored in a mental lexicon that depends on the temporal-lobe-based declarative memory system that also underlies conceptual knowledge. In contrast, evidence suggests that rule-governed combination (e.g., in regular past tenses; walk+-ed) takes place in a mental grammar that relies on the frontal/basal-ganglia-based procedural memory system, which also underlies motor skills such as how to use a hammer. We found that TS children were significantly faster than typically developing control children in producing rule-governed past tenses (slip-slipped, plim-plimmed, bring-bringed) but not irregular and other unpredictable past tenses (bring-brought, splim-splam). They were also faster than controls in naming pictures of manipulated (hammer) but not non-manipulated (elephant) items. These data were not explained by a wide range of potentially confounding subject- and item-level factors. The results suggest that the processing of procedurally based knowledge, both of grammar and of manipulated objects, is particularly speeded in TS. The frontal/basal-ganglia abnormalities may thus lead not only to tics, but also to a wider range of rapid behaviors, including the cognitive processing of rule-governed forms in language and other types of procedural knowledge.

[In an experiment that analyzed the abilities of children with TS to come up with novel word forms in the context of a sentence, TS children were faster at producing rule-governed past tenses then control children. In an experiment that analyzed how fast children with TS could name pictures of objects, children with TS were faster than controls at naming manipulated (like a tool) objects.]

[a] Racism, A Sociological Perspective by Nicki Lisa Cole at sociology.about.com

[b] Why Black People can use the N-word: A Perspective by African American at Word. The Online Journal on African American English

[1] Negativity Bias. In Wikipedia, retrieved on 7/6/15 from https://en.wikipedia.org/wiki/Negativity_bias

[2] Bias. In Wikipedia, retrieved on 7/6/2015 from https://en.wikipedia.org/wiki/Bias

[3] Type I error (false positive error). In Wikipedia, retrieved on 7/6/15 from https://en.wikipedia.org/wiki/Type_I_and_type_II_errors#Type_I_error

[4] Type II error (false negative error). In Wikipedia, retrieved on 7/6/15 from https://en.wikipedia.org/wiki/Type_I_and_type_II_errors#Type_II_error

[5] Maslow’s Hierarchy of Needs. In Wikipedia, retrieved on 7/6/15 from https://en.wikipedia.org/wiki/Maslow%27s_hierarchy_of_needs

[6] Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.

The American Psychiatric Association, May 18, 2013.

[7] Neurodevelopmental Disorder. In Wikipedia, retrieved on 7/6/2015 from https://en.wikipedia.org/wiki/Neurodevelopmental_disorder

[8] Towards objectively quantifying sensory hypersensitivity: a pilot study of the “Ariana effect”.

Panagopoulos et al. PeerJ. 2013 Aug 1;1:e121.

[9] Talent in autism: hyper-systemizing, hyper-attention to detail and sensory hypersensitivity.

Baron-Cohen et al. Philos Trans R Soc Lond B Biol Sci. 2009 May 27; 364(1522): 1377–1383.

[10] Inflectional morphology in high-functioning autism: Evidence for speeded grammatical processing.

Walenski et al. Res Autism Spectr Disord. 2014 Nov 1;8(11):1607-1621.

[11] Obsessions and Autism. At autism.org.uk on 7/2/15.

[12] Tourette’s syndrome, trichotillomania, and obsessive-compulsive disorder: how closely are they related?

Ferrão et al. Psychiatry Res. 2009 Nov 30;170(1):32-42.

On a theoretical continuum of tics and compulsions, it can be hypothesized that a nodal point exists where the shift from“unintentional” to “intentional” repetitive behaviors takes place. Subjective experiences that precede these behaviors may be helpful in defining this demarcation (Miguel et al., 1995), and may be particularly useful to investigate in the subgroup of OCD with tics. OCD patients with tics often report compulsions not preceded by obsessions, and instead usually perform their repetitive behaviors to relieve sensory phenomena (i.e., bodily sensations, general feelings), or to reach a specific sensation or feeling “just-right” (Leckman et al., 1994; Miguel et al., 1995, 1997, 2000).
In terms of type of obsessive–compulsive symptoms, patients with OCD plus tics more frequently report intrusive violent, sexual, religious images/thoughts, somatic obsessions, counting rituals, tic-like compulsions, and hoarding (George et al., 1993; Holzer et al., 1994; Eapen et al.,1997; Petter et al.,1998; Swerdlowet al.,1999; Diniz et al., 2005). When symptoms are measured based on dimensions, the aggressive/ sexual/religious factor and the symmetry/ordering/arranging factor are also more frequently associated with the OCD plus tics subtype (Leckman et al., 1997; Hasler et al., 2005).

[12] The psychopathological spectrum of Gilles de la Tourette syndrome.

Cavanna et al. Neurosci Biobehav Rev. 2013 Jul;37(6):1008-15.

Moreover, it has been observed that obsessive–compulsive symptoms in people with tics have their own character (Frankel et al., 1986; George et al., 1993). Compulsions tend to be more related to counting, symmetry and “just right” thoughts or actions. Typical examples of this include having to cross a door threshold in a certain manner, counting all the floor tiles in a room or having to perform a tic in a particular way (which can lead to repetitive tics). Intrusive aggressive or inappropriate sexual thoughts and images are relatively common in people with GTS, whilst the obsessive–compulsive symptoms in pure OCD tend to be more related to fears about contamination or harm coming to another person (e.g. Frankel et al., 1986; George et al., 1993; Cavanna et al., 2006b; Worbe et al., 2010). Frankel et al. (1986) reported that patients with GTS had significantly higher obsessional scores on a specially designed inventory when compared to controls. The obsessional items endorsed by GTS patients changed with increasing age, with younger patients endorsing more items to do with impulse control, and older subjects endorsing items about checking, arranging and fear of contamination. Cluster analysis of the inventory responses revealed a group of seven questions that were preferentially endorsed by GTS patients (blurting obscenities, counting compulsions, impulsions to hurt oneself) and eleven questions elicited high scores from OCD patients (ordering, arranging, routines, rituals, touching one’s body, obsessions about people hurting each other). George et al. (1993) showed that patients with GTS and co-morbid OCD have significantly more violent, sexual and symmetrical obsessions and more touching, blinking, counting, and self-damaging compulsions, compared to patients with OCD only, who have more obsessions concerning dirt or germs and more compulsions about cleaning. The phenomenological differences between the repetitive behaviours encountered in GTS and OCD have been consistently reported in further studies (e.g. Worbe et al., 2010). The current view is that GTS and OCD can share some neurobiological underpinnings, and that specific obsessive–compulsive symptoms are likely to be intrinsic to GTS (Robertson, 2000; Lombroso and Scahill, 2008; Cavanna et al., 2009a).

[14] Specialisterne company website “about” page, US branch.

Specialisterne (which translates from Danish as “The Specialists”) is an innovative social business concept originally founded in Denmark in 2004. Specialisterne is internationally recognized as the first and foremost example of how high functioning people with autism (Autism Spectrum Disorder) can become effectively included in society, and provide valuable, high quality services to their employers.

[15] A Natural Fix for A.D.H.D. From The New York Times by Richard A. Friedman on 10/31/14

[16] The Creative Gifts of ADHD. From Scientific American by Scott Barry Kaufman on 10/21/14

[17] Bother Me, I’m Thinking. From The Wall Street Journal by Jonah Lehrer on 2/19/11

[18] Up In Your Head: Can Having Tourette Syndrome Make You a Superior Athlete? On Yahoo News by Joseph Diaz and Lauren Effron on 8/14/2014

[19] Dr. Samuel Johnson. In Wikipedia, retrieved on 7/6/15 from https://en.wikipedia.org/wiki/Samuel_Johnson

[20] Time processing in children with Tourette’s syndrome.

Vicario et al. Brain Cogn. 2010 Jun;73(1):28-34.

[21] Smooth pursuit and fixation ability in children with Tourette syndrome.

Tajik-Parvinchi et al. Cogn Behav Neurol. 2011 Dec;24(4):174-86.

[22] Enhanced antisaccade abilities in children with Tourette syndrome: the Gap-effect Reversal.

Tajik-Parvinchi et al. Front Hum Neurosci. 2013 Nov 13;7:768.

[23] Speeded processing of grammar and tool knowledge in Tourette’s syndrome.

Walenski et al. Neuropsychologia. 2007 Jun 18;45(11):2447-60.

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One response to “Cognitive enhancements and mental conditions #1: the “negative medical bias problem”.

  1. Pingback: What are we as objects? From experience to the brain through the mind. Also crabs… | A Demon Speaks

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