Correlation of Comorbidities and Variability of Tics in Children with Chronic Tic Disorder

Abstract

Objective Chronic tic disorder (CTD) is characterized by the presence of motor and/or phonic tics, and is often accompanied by comorbidities, where obsessive-compulsive disorder (OCD) and attention deficit hyperactivity disorder (ADHD) are the most predominant. The aim of this study was to investigate a correlation between comorbidities and variability of tics in children with CTD.

Method A cross-sectional study was completed on a clinical cohort recruited from the Danish National Tourette Clinic at Herlev Hospital. The cohort consisted of 167 children who were examined by the Yale Global Tic Severity Scale. Data regarding comorbidity were collected on 152 of these patients by using validated diagnostic instruments, and the patients were divided into four subgroups: CTD-only, CTD + ADHD, CTD + OCD, and CTD + ADHD + OCD.

Results The comorbidity subgroups had significantly higher severity, impairment, and Total Tic Scores compared to the CTD-only group (p-value ≤ 0.001, 0.001, 0.003, respectively). The assessment of the association between variability of tics and comorbidities showed a significantly higher Simple Phonic Tic Score in the CTD + OCD group compared to the CTD-only group (p-value = 0.003).

Conclusion This study showed significantly higher Simple Phonic Tic Scores in the CTD + OCD group compared to the CTD-only group, which suggests that awareness of the variability of tics in patients with CTD and comorbidities is important.

Total Tic Scores, severity of tics, and impairment were significantly higher in the comorbidity subgroups compared to the CTD-only group, which support findings from previous studies.

Keywords

chronic tic disorder - comorbidity - severity of tics

Data Statement

Data can be obtained by contacting the corresponding author.

Publikationsverlauf

Eingereicht: 21. Februar 2024

Angenommen: 13. Juni 2024

Artikel online veröffentlicht:
11. Juli 2024

• References

• 1 Association AP. Diagnostic and Statistical Manual of Mental Disorders (DSM-5®). Washington, DC: American Psychiatric Publishing; 2013
• 2 Szejko N, Robinson S, Hartmann A. et al. European clinical guidelines for Tourette syndrome and other tic disorders-version 2.0. Part I: assessment. Eur Child Adolesc Psychiatry 2022; 31 (03) 383-402
• 3 Cath DC, Hedderly T, Ludolph AG. et al. ESSTS Guidelines Group. European clinical guidelines for Tourette syndrome and other tic disorders. Part I: assessment. Eur Child Adolesc Psychiatry 2011; 20 (04) 155-171
• 4 Paschou P, Fernandez TV, Sharp F, Heiman GA, Hoekstra PJ. Genetic susceptibility and neurotransmitters in Tourette syndrome. Int Rev Neurobiol 2013; 112: 155-177
• 5 Groth C, Mol Debes N, Rask CU, Lange T, Skov L. Course of Tourette syndrome and comorbidities in a large prospective clinical study. J Am Acad Child Adolesc Psychiatry 2017; 56 (04) 304-312
• 6 Roessner V, Plessen KJ, Rothenberger A. et al. ESSTS Guidelines Group. European clinical guidelines for Tourette syndrome and other tic disorders. Part II: pharmacological treatment. Eur Child Adolesc Psychiatry 2011; 20 (04) 173-196
• 7 Robertson MM. A personal 35 year perspective on Gilles de la Tourette syndrome: prevalence, phenomenology, comorbidities, and coexistent psychopathologies. Lancet Psychiatry 2015; 2 (01) 68-87
• 8 Freeman RD, Fast DK, Burd L, Kerbeshian J, Robertson MM, Sandor P. An international perspective on Tourette syndrome: selected findings from 3,500 individuals in 22 countries. Dev Med Child Neurol 2000; 42 (07) 436-447
• 9 Hirschtritt ME, Lee PC, Pauls DL. et al. Tourette Syndrome Association International Consortium for Genetics. Lifetime prevalence, age of risk, and genetic relationships of comorbid psychiatric disorders in Tourette syndrome. JAMA Psychiatry 2015; 72 (04) 325-333
• 10 Channon S, Gunning A, Frankl J, Robertson MM. Tourette's syndrome (TS): cognitive performance in adults with uncomplicated TS. Neuropsychology 2006; 20 (01) 58-65
• 11 Mol Debes NMM. Co-morbid disorders in Tourette syndrome. Behav Neurol 2013; 27 (01) 7-14
• 12 Rizzo R, Curatolo P, Gulisano M, Virzì M, Arpino C, Robertson MM. Disentangling the effects of Tourette syndrome and attention deficit hyperactivity disorder on cognitive and behavioral phenotypes. Brain Dev 2007; 29 (07) 413-420
• 13 Grados MA, Mathews CA. Tourette Syndrome Association International Consortium for Genetics. Latent class analysis of gilles de la tourette syndrome using comorbidities: clinical and genetic implications. Biol Psychiatry 2008; 64 (03) 219-225
• 14 Leckman JF, Riddle MA, Hardin MT. et al. The Yale Global Tic Severity Scale: initial testing of a clinician-rated scale of tic severity. J Am Acad Child Adolesc Psychiatry 1989; 28 (04) 566-573
• 15 Scahill L, Riddle MA, McSwiggin-Hardin M. et al. Children's Yale-Brown Obsessive Compulsive Scale: reliability and validity. J Am Acad Child Adolesc Psychiatry 1997; 36 (06) 844-852
• 16 Bloch MH, Peterson BS, Scahill L. et al. Adulthood outcome of tic and obsessive-compulsive symptom severity in children with Tourette syndrome. Arch Pediatr Adolesc Med 2006; 160 (01) 65-69
• 17 Szomlaiski N, Dyrborg J, Rasmussen H, Schumann T, Koch SV, Bilenberg N. Validity and clinical feasibility of the ADHD rating scale (ADHD-RS) A Danish Nationwide Multicenter Study. Acta Paediatr 2009; 98 (02) 397-402
• 18 Mol Debes NMM, Hjalgrim H, Skov L. Validation of the presence of comorbidities in a Danish clinical cohort of children with Tourette syndrome. J Child Neurol 2008; 23 (09) 1017-1027
• 19 Rizzo R, Gulisano M, Calì PV, Curatolo P. Long term clinical course of Tourette syndrome. Brain Dev 2012; 34 (08) 667-673
• 20 Groth C. Tourette syndrome in a longitudinal perspective. Clinical course of tics and comorbidities, coexisting psychopathologies, phenotypes and predictors. Dan Med J 2018; 65 (04) B5465
• 21 Szejko N, Müller-Vahl KR. Challenges in the diagnosis and assessment in patients with tourette syndrome and comorbid obsessive-compulsive disorder. Neuropsychiatr Dis Treat 2021; 17: 1253-1266
• 22 Brandt V, Otte J-H, Fremer C, Jakubovski E, Müller-Vahl K. Non-just-right experiences are more closely related to OCD than tics in Tourette patients. Sci Rep 2023; 13 (01) 19627
• 23 Mansueto CS, Keuler DJ. Tic or compulsion?: it's Tourettic OCD. Behav Modif 2005; 29 (05) 784-799
• 24 Sheppard DM, Bradshaw JL, Purcell R, Pantelis C. Tourette's and comorbid syndromes: obsessive compulsive and attention deficit hyperactivity disorder. A common etiology?. Clin Psychol Rev 1999; 19 (05) 531-552