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The trichotillomania scale for children: Development and validation

The Institute of Living, Anxiety Disorders Center, 200 Retreat Avenue, Hartford, CT 06106, USA.
Child Psychiatry and Human Development (Impact Factor: 1.93). 10/2008; 39(3):331-49. DOI: 10.1007/s10578-007-0092-3
Source: PubMed

ABSTRACT Trichotillomania (TTM) is a chronic impulse control disorder characterized by repetitive hair-pulling resulting in alopecia. Although this condition is frequently observed in children and adolescents, research on pediatric TTM has been hampered by the absence of validated measures. The aim of the present study was to develop and test a new self-report measure of pediatric TTM, the Trichotillomania Scale for Children (TSC), a measure that can be completed by children and/or their parents. One hundred thirteen children meeting self-report criteria for TTM, and 132 parents, provided data over the internet. An additional 41 child-parent dyads from an outpatient clinic also provided data. Replicated principal components analysis, with elimination of poorly-loading items, yielded two components, which we labeled Severity (five items) and Distress/Impairment (seven items). The TSC total score and subscales showed adequate internal consistency and test-retest reliability. Parent-child agreement was good in the internet sample, but more modest in the clinic sample. Children's TSC scores correlated significantly with other measures of TTM severity, although some exceptions were noted. Parents' TSC scores correlated significantly with other measures of parent-rated TTM severity in the internet sample, but showed more attenuated relationships with child- and interviewer-rated TTM severity in the clinic sample. The present results suggest that the TSC may be a useful measure of TTM for child and adolescent samples, although additional clarification of convergent validity is needed.

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Available from: David F Tolin, Jan 27, 2014
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    • "In order of preference, preferred clinician-rating scales included the National Institute of Mental Health-Trichotillomania Severity Scale (NIMH-TSS; Swedo et al., 1989), Psychiatric Institute Trichotillomania Scale (PITS; Winchel et al., 1992), and the Yale-Brown Obsessive Compulsive Scale modified for Trichotillomania (Y-BOCS- TTM; Stanley et al., 1999). In the absence of clinician ratings, selfreport measures of hair pulling severity were preferred, which included the MGH-HPS (Keuthen et al., 1995; O'Sullivan et al., 1995) and the Trichotillomania Scale for Children and Parents (Tolin et al., 2008). When standardized ratings scales were unavailable, selfreported ratings of hair pulling severity were utilized that included weekly ratings of hair pulling severity (Christenson et al., 1991a; Streichenwein and Thornby, 1995), and the number of daily hair pulling episodes (Azrin et al., 1980). "
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    ABSTRACT: Few randomized controlled trials (RCTs) exist examining the efficacy of behavior therapy (BT) or serotonin reuptake inhibitors (SRIs) for the treatment of trichotillomania (TTM), with no examination of treatment moderators. The present meta-analysis synthesized the treatment effect sizes (ES) of BT and SRI relative to comparison conditions, and examined moderators of treatment. A comprehensive literature search identified 11 RCTs that met inclusion criteria. Clinical characteristics (e.g., age, comorbidity, therapeutic contact hours), outcome measures, treatment subtypes (e.g., SRI subtype, BT subtype), and ES data were extracted. The standardized mean difference of change in hair pulling severity was the outcome measure. A random effects meta-analysis found a large pooled ES for BT (ES= 1.41, p< 0.001). BT trials with greater therapeutic contact hours exhibited larger ES (p= 0.009). Additionally, BT trials that used mood enhanced therapeutic techniques exhibited greater ES relative to trials including only traditional BT components (p= 0.004). For SRI trials, a random effects meta-analysis identified a moderate pooled ES (ES= 0.41, p= 0.02). Although clomipramine exhibited larger ES relative to selective serotonin reuptake inhibitors, the difference was not statistically significant. Publication bias was not identified for either treatment. BT yields large treatment effects for TTM, with further examination needed to disentangle confounded treatment moderators. SRI trials exhibited a moderate pooled ES, with no treatment moderators identified. Sensitivity analyses highlighted the need for further RCTs of SRIs, especially among youth with TTM.
    Journal of Psychiatric Research 11/2014; 58. DOI:10.1016/j.jpsychires.2014.07.015 · 4.09 Impact Factor
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    • "Trichotillomania scale for children (TSC). The TSC [Tolin et al., 2008] "
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    ABSTRACT: Little is known about the etiology of hair pulling (HP) and its relationship to other obsessive compulsive (OC) spectrum disorders. In a large-sample family study, we examined the familial aggregation of HP and co-transmission of obsessive compulsive disorder (OCD) and skin picking (SP). Our sample consisted of 110 proband cases with HP and 48 controls without HP, plus 128 first-degree case relatives and 50 first-degree control relatives. Case versus control relatives had higher recurrence risk estimates for both HP and OCD but not SP. The finding that HP is familial is consistent with the only existing twin study. Additional analyses suggest that there may be a familial subtype of HP with comorbid OCD. Those adult proband cases with HP + OCD had more anxiety and depression than cases without OCD. Probands with HP + OCD also had earlier onset of OCD. Identification of an HP subtype with comorbid OCD may have significant theoretical and treatment implications. The data did not provide evidence for an etiologic relationship between HP and SP. Replication of these findings in future studies with larger cohorts of case and control relatives is warranted. © 2014 Wiley Periodicals, Inc.
    American Journal of Medical Genetics Part B Neuropsychiatric Genetics 03/2014; 165(2). DOI:10.1002/ajmg.b.32218 · 3.27 Impact Factor
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    • "and the mean automatic pulling score was 13.3 (SD = 8.7). The Trichotillomania Scale for Children (TSC; Tolin et al., 2008) is completed by the patient at the start of each session to assess pulling severity. The TSC is a 12-item measure assessing both pulling severity and pulling-related distress/impairment. "
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    ABSTRACT: Although several studies have examined the efficacy of Acceptance Enhanced Behavior Therapy (AEBT) for the treatment of trichotillomania (TTM) in adults, data are limited with respect to the treatment of adolescents. Our case series illustrates the use of AEBT for TTM in the treatment of two adolescents. The AEBT protocol (Woods & Twohig, 2008) is a structured treatment manual that was adapted to the individual clients’ needs and clinical progress. Both clients reported clinically significant gains in treatment as determined by at least 2 weeks of abstinence from pulling, and subjective reports of decreased distress and impairment, although one required a booster session due to relapse. AEBT is worth further exploration as a treatment for adolescents with TTM.
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