Psychological morbidity and caregiver burden in parents of children with Tourette's disorder and psychiatric comorbidity

The diagnosis of Tourette's Syndrome: communication and impact

No study to date has investigated differences in perception regarding the manner in which a diagnosis of Tourette's Syndrome (TS) is communicated and the impact that this diagnosis can have on patients, as well as their relatives and physicians. The main objective was to explore the personal experiences regarding the communication and impact of a TS diagnosis on those who receive the diagnosis, their caregivers and physicians. A qualitative research methodology was used in this study, based on the use of focus groups (FGs). All health professionals, persons with TS and their relatives said that TS was difficult to diagnose. However, each group perceived different causes for the difficulty. Physicians cited the complexity of the symptoms, while the patients themselves noted the general lack of knowledge regarding the disease. In adittion, the physicians and the relatives both noted that the symptoms of TS were often hidden behind family guilt. The communication of the diagnosis to relatives of children with TS was not adequate because of poor understanding and interpretation of the clinical terminology. The most important conclusion was that the current method for communicating the diagnosis of TS to patients and relatives should be improved to facilitate better understanding and interpretation.

Disentangling the effects of Tourette syndrome and attention deficit hyperactivity disorder on cognitive and behavioral phenotypes

Eighty participants (62 males; 18 females; age range: 6-16 years) took part in the study, comprising four groups of 20 subjects each: TS-only, ADHD-only, TS+ADHD, controls. The age distributions, did not differ significantly among the four groups. The severity of symptoms, assessed by the TSGS, did not differ significantly between the two TS groups. Standardised measures were used throughout. The "cases" (i.e. TS-only, TS+ADHD, ADHD-only) were significantly different from controls on most measures of behavior. There were also differences amongst the various clinical subgroups, with, in general, TS-only participants being similar to controls with regards to both "total behavior" ratings and cognitive testing results. A diagnosis of ADHD, either or its own or in association with TS, was associated with greater maladaptive behavior and worse cognitive functioning. With regards to affective symptoms and anxiety, the three clinical groups did not differ from each other, but each of them was more affected than the control group. One finding in our study which differed from previous literature was that TS-only patients were rated as more "delinquent" than controls by their parents: possible reasons for this are discussed. Oppositional defiant disorder (ODD) was seen in a few (2,3,3 ODD patients in each clinical group), but as numbers were small no statistics were undertaken. Family histories were in accord with both TS and ADHD being genetic disorders, but sharing an overlap in only some cases. The "additive effect" hypothesis is discussed in detail in the light of our results and recent literature.

Gilles de la Tourette's syndrome and its impact in the UK

Gilles de la Tourette's syndrome of chronic multiple motor and vocal tics is now acknowledged to be far more common than once thought, affecting up to 1% of schoolchildren with a wide range of severity. At the milder end of the spectrum the associated psychopathologies can in themselves impair social and educational functioning, in particular obsessive compulsive disorder and attention deficit hyperactivity disorder. Many patients with this condition are not being adequately served by health and education services in the UK. The epidemiology, clinical features, aetiological factors, and management of the syndrome are reviewed.