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Wardrop RC, Lewin AB, Adams HR, Vermilion JA, Cuffe SP, Danielson ML, Bitsko RH, Cai B, Hardin JW. Improving Identification of Tic Disorders in Children. EVIDENCE-BASED PRACTICE IN CHILD AND ADOLESCENT MENTAL HEALTH 2024; 9:262-280. [PMID: 39157297 PMCID: PMC11328645 DOI: 10.1080/23794925.2024.2324775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/20/2024]
Abstract
This study combines data from five studies in a quantitative modeling approach to improve identification of tics and tic disorders using two questionnaires (the Motor or Vocal Inventory of Tics and the Description of Tic Symptoms), administered to parents and childrenN = 1 , 307 . Combining final diagnoses (positive or negative for tic disorder) with data from recently developed questionnaires implemented to assist in the identification of tics and tic disorders in children, we investigate methods for predicting positive diagnosis while also identifying which items in the questionnaires are most predictive. Logistic regression and random forest models are compared using various summary statistics. We further discuss the differences in errors (false positives versus false negatives) in the specification of predictive model tuning parameters. Compared to logistic regression models, random forest models provided comparable and often superior predictive abilities and were also more useful in summarizing the contributions to predictions from individual questions. The combined analyses identified a subset of screener questions that were the best predictors of tic disorders; the identified questions differed based on parent or self-report. These results provide information to inform the future development of tools to screen for tics in a variety of healthcare and epidemiological settings.
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Affiliation(s)
- Rebecca C. Wardrop
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, USA
| | - Adam B. Lewin
- Department of Pediatrics, University of South Florida, Tampa, USA
| | - Heather R. Adams
- Department of Neurology & Department of Pediatrics, University of Rochester Medical Center, Rochester, New York, USA
| | - Jennifer A. Vermilion
- Department of Neurology & Department of Pediatrics, University of Rochester Medical Center, Rochester, New York, USA
| | - Steven P. Cuffe
- Department of Psychiatry, University of Florida College of Medicine – Jacksonville, USA
| | - Melissa L. Danielson
- Division of Human Development and Disability, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Rebecca H. Bitsko
- Division of Human Development and Disability, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Bo Cai
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, USA
| | - James W. Hardin
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, USA
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2
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Lewin AB, Murphy TK, Mink JW, Small BJ, Adams HR, Brennan E, Augustine EF, Vermilion J, Vierhile A, Collins A, Kudryk K, Dickinson S, Danielson ML, Bitsko RH. Brief youth self-report screener for tics: Can a subscale of the Motor tic, Obsession and compulsion, and Vocal tic Evaluation Survey (MOVES) identify tic disorders in youth? EVIDENCE-BASED PRACTICE IN CHILD AND ADOLESCENT MENTAL HEALTH 2023; 8:1-11. [PMID: 37323827 PMCID: PMC10267813 DOI: 10.1080/23794925.2023.2191354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Tics are unwanted, repetitive movements and sounds that frequently present during childhood. They are typically brief and purposeless, but can create significant distress for individuals, and often co-occur with other neuropsychiatric conditions. Thus, early identification of tics is warranted. Unfortunately, tics are often misdiagnosed, and because tics may wax and wane, identification can be difficult, especially in the context of routine clinical visits. There are limited tools that can be used to reliably identify tics in clinical practice, especially in non-specialty settings. The purpose of the current study was to evaluate the performance of the Motor tic, Obsession and compulsion, and Vocal tic Evaluation Survey (MOVES), a self-report scale with some support as a screening tool. In addition, the performance of a subset of questions (the MOVES-6) was evaluated for rapid screening. Participants were recruited across two study sites and included children and adolescents diagnosed with Tourette syndrome (n = 151) or another persistent tic disorder (n = 10) and community controls (n = 74). Results suggest both the MOVES and the MOVES-6 have high sensitivity (90% and 88%, respectively) and at least acceptable specificity (77% and 86%, respectively) compared with expert assessment of tic disorders, suggesting that both versions can identify tic disorders without high proportions of false negatives. Both versions were highly sensitive with acceptable specificity regardless of sex, race/ethnicity, and age. The MOVES and MOVES-6 show promise as a screener for tics or tic disorders, but additional research is needed, particularly in a general population setting.
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Smith JN, Owens JS, Evans SW, Bitsko RH, Holbrook JR. A Population-Based Study of the Utility of Screening for Tics and the Relative Contribution of Tics and Psychiatric Comorbidity to Academic and Social Impairment in Adolescents. EVIDENCE-BASED PRACTICE IN CHILD AND ADOLESCENT MENTAL HEALTH 2023; 9:192-204. [PMID: 38883230 PMCID: PMC11177595 DOI: 10.1080/23794925.2023.2263856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Abstract
This study examined the performance of a brief screening tool for tics in adolescents. Academic and social impairment in students by tic screen status and emotional/behavioral problem status were examined. Data were collected as part of an epidemiologic study, the Project to Learn about Youth - Mental Health. Participants were 2,312 secondary school students at the Ohio site (47.4% female; 94.4% non-Hispanic white) and their teachers. Students completed 6 items from the Motor tic, Obsessions and compulsions, Vocal tic Evaluation Survey (MOVES-6) and the Strengths and Difficulties Questionnaire (SDQ). Teachers completed the Proxy Report Questionnaire for tics and SDQ. Based on responses to the MOVES-6, 11.1% of students screened positive for tics. Internal consistency was adequate (α = 0.76); inter-rater consistency between teachers and students was low (0.03). Based on student self-report, those who screened positive for tics self-reported more academic and social impairment than students who screened negative for tics; teacher-report of impairment was similar between those with a positive or negative tic screen. Students who screened positive for tics and reported internalizing difficulties reported more academic and social impairment than students with only a positive tic screen. Teachers perceived those screening positive for tics and externalizing difficulties as the most socially impaired. In conclusion, a positive self-reported tic screen was associated with self-reported academic and social impairment. Findings reveal the independent contribution of tics to impairment, even when internalizing and externalizing problems are present, and the potential utility of a school-based screening for tics in adolescents.
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Affiliation(s)
| | | | - Steven W. Evans
- Department of Psychology, Ohio University, Athens, Ohio, USA
| | - Rebecca H. Bitsko
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Joseph R. Holbrook
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
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Cree RA, Bitsko RH, Danielson ML, Wanga V, Holbrook J, Flory K, Kubicek LF, Evans SW, Owens JS, Cuffe SP. Surveillance of ADHD Among Children in the United States: Validity and Reliability of Parent Report of Provider Diagnosis. J Atten Disord 2023; 27:111-123. [PMID: 36326292 PMCID: PMC9843610 DOI: 10.1177/10870547221131979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To evaluate the appropriateness of parent-reported diagnosis of ADHD as a surveillance tool. METHOD We assessed agreement over time and concordance of parent-reported diagnosis against Diagnostic and Statistical Manual (DSM)-based criteria. We compared concordance of diagnosis and DSM-based criteria by child characteristics, including treatment. RESULTS Among parents who reported their child had ADHD, 95.7% reported it again 2 years later. Comparing diagnosis with DSM-based criteria, specificity and negative predictive value were high, sensitivity was moderate, and positive predictive value was low. Most children with an ADHD diagnosis who did not meet DSM-based criteria met sub-threshold criteria or took medication for ADHD. Concordance differed by child characteristics and treatment. CONCLUSION Parent-reported diagnosed ADHD is reliable over time. Although differences in parent-reported diagnosis and DSM-based criteria were noted, these may reflect children with milder symptoms or treated ADHD. Parent-report of child ADHD ever diagnosis may be a good single-item indicator for prevalence.
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Affiliation(s)
- Robyn A. Cree
- US Centers for Disease Control and Prevention, Atlanta, GA, USA
- Epidemic Intelligence Service, Atlanta, GA, USA
| | | | | | - Valentine Wanga
- US Centers for Disease Control and Prevention, Atlanta, GA, USA
- Epidemic Intelligence Service, Atlanta, GA, USA
| | - Joseph Holbrook
- US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kate Flory
- University of South Carolina, Columbia, SC, USA
| | | | | | | | - Steven P. Cuffe
- University of Florida College of Medicine, Jacksonville, USA
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Johansson V, Norén Selinus E, Kuja-Halkola R, Lundström S, Durbeej N, Anckarsäter H, Lichtenstein P, Hellner C. The Quantified Behavioral Test Failed to Differentiate ADHD in Adolescents With Neurodevelopmental Problems. J Atten Disord 2021; 25:312-321. [PMID: 30024318 DOI: 10.1177/1087054718787034] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: The Quantified Behavioral Test (QbTest) is a computerized diagnostic test for ADHD, used in clinical psychiatric care, but its validity may be questioned. We analyzed the QbTest's diagnostic validity and its relation to cognitive ability and psychosocial factors in an adolescent population with a high occurrence of neurodevelopmental disorders. Method: In total, 340 participants aged 15 years, completed the QbTest, along with questionnaires, clinical and intelligence quotient (IQ) assessments. Results: The clinical assessment resulted in 89 (26%) participants with ADHD. Area under curve (AUC) scores indicated a random to poor validity of the QbTest (AUC range = 0.48-0.64). QbTest scores of inattention and impulsivity correlated with IQ. Conclusion: The QbTest was insufficient as a diagnostic test for ADHD, and was not able to differentiate ADHD from other neurodevelopmental conditions. Clinicians should be aware of the dubious discriminating power of the QbTest.
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Affiliation(s)
- Viktoria Johansson
- Karolinska Institutet, Stockholm, Sweden.,Stockholm County Council, Sweden
| | - Eva Norén Selinus
- Karolinska Institutet, Stockholm, Sweden.,Stockholm County Council, Sweden
| | | | | | - Natalie Durbeej
- Karolinska Institutet, Stockholm, Sweden.,Uppsala University, Sweden
| | | | | | - Clara Hellner
- Karolinska Institutet, Stockholm, Sweden.,Stockholm County Council, Sweden
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Ho CS, Huang JY, Yang CH, Lin YJ, Huang MY, Su YC. Is the Yale Global Tic Severity Scale a valid tool for parent-reported assessment in the paediatric population? A prospective observational study in Taiwan. BMJ Open 2020; 10:e034634. [PMID: 32819930 PMCID: PMC7440819 DOI: 10.1136/bmjopen-2019-034634] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE The Yale Global Tic Severity Scale (YGTSS) is the most commonly used clinician-rated evaluation tool for Tourette syndrome (TS), with established reliability and validity. This study aims to determine whether the YGTSS is a valid parent-reported assessment in the TS population. DESIGN A prospective cohort study. SETTING A major medical centre in Taiwan. METHODS A total of 594 patients were enrolled. A revised traditional Chinese version of the YGTSS was made available to parents via Google docs. Parents were encouraged to complete the YGTSS the day before each outpatient clinic visit. At each visit, a paediatric neurology fellow also administered the YGTSS assessment. We investigated whether differences in scores between physicians and parents changed as the number of parent evaluations increased. The results of the physician assessments were also taken as the expert standard for evaluating the sensitivity and specificity of the parent-reported assessments was conducted for the same visit. RESULTS The differences in the YGTSS scores between participants and physicians were small. The mean difference in the total assessment score was 4.15 points. As the number of times the parent evaluation was performed increased, the difference between the parent and physician scores decreased. Discrimination of moderate-to-severe attacks was good using the parent-assessed YGTSS (area under the receiver operating characteristic curve, 0.858; 95% CI 0.839 to 0.876). The sensitivity for detecting a moderate-to-severe attack by YGTSS parent assessment was 79.7% (95% CI 76.6 to 82.8), and the specificity was 91.8% (95% CI 89.9 to 93.7). CONCLUSION The parent-reported YGTSS is a promising tool for TS assessment, demonstrating good discriminative ability for disease severity, with user precision increasing with experience.
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Affiliation(s)
- Che-Sheng Ho
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
- Division of Pediatric Neurology, Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan
| | - Jia-Yun Huang
- Division of Pediatric Neurology, Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan
| | - Chien-Hui Yang
- Division of Pediatric Neurology, Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan
| | - Yi-Jie Lin
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
- Division of Pediatric Neurology, Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan
| | - Ming-Yuan Huang
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
- Department of Emergency Medicine, Mackay Memorial Hospital, Taipei, Taiwan
| | - Yung-Cheng Su
- Emergency Department, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
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Chronic recurrent dislocation of the temporomandibular joint secondary to a complex facial tic disorder. Br J Oral Maxillofac Surg 2017; 55:1045-1046. [DOI: 10.1016/j.bjoms.2017.08.371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 08/20/2017] [Indexed: 11/22/2022]
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Cubo E, Gonzalez C, Ausin V, Delgado V, Saez S, Calvo S, Garcia Soto X, Cordero J, Kompoliti K, Louis ED, de la Fuente Anuncibay R. The Association of Poor Academic Performance with Tic Disorders: A Longitudinal, Mainstream School-Based Population Study. Neuroepidemiology 2017; 48:155-163. [PMID: 28768287 DOI: 10.1159/000479517] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 07/11/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Little is known about the academic performance of students with tic disorders (TD). Our aim was to investigate the association of TD and poor academic performance over time. METHODS Longitudinal, observational study of mainstream schoolchildren comparing grade retention (GR) and learning disorders (LD) in students with vs. without TD between 2010 and 2014. Students with vs. without TD based on DSM-IV-TR criteria, or with vs. without GR and LD were compared in terms of comorbidities, school, and environmental characteristics. The association of TD with GR was analyzed using hazard ratios (HRs) with 95% CIs, and with LD using logistic regression analysis [Odds ratio (OR)]. RESULTS Two hundred fifty-eight students were included (mean age 14.0 ± 1.71 years, 143 [55.4%] males). The incident rate for TD and GR was 2.6 and 3.3 per 100 persons-year, respectively. LD found in 21 (9.9%) students was associated with TD (OR 11.62, 95% CI 2.21-60.90, p = 0.004), and attention deficit hyperactivity disorder (ADHD; OR 6.63, 95% CI 1.55-28.37, p = 0.01). Low psychological support (HRs 12.79, 95% CI 3.39-48.17) and low sport participation (HRs 6.41, 95% CI 1.54-26.78) were risk factors for GR. CONCLUSIONS TD was associated with academic difficulties, namely, LD in conjunction with ADHD but not GR. The diagnosis of TD and comorbidities, and the initiation of proper treatment could have a favorable impact on school performance, and consequently on social development.
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Affiliation(s)
- Esther Cubo
- Department of Neurology, Hospital Universitario Burgos, Burgos, Spain
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Martino D, Pringsheim TM, Cavanna AE, Colosimo C, Hartmann A, Leckman JF, Luo S, Munchau A, Goetz CG, Stebbins GT, Martinez-Martin P. Systematic review of severity scales and screening instruments for tics: Critique and recommendations. Mov Disord 2017; 32:467-473. [PMID: 28071825 DOI: 10.1002/mds.26891] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 11/02/2016] [Accepted: 11/09/2016] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Several clinician, informant, and self-report instruments for tics and associated phenomena have been developed that differ in construct, comprehensiveness, and ease of administration. OBJECTIVE A Movement Disorders Society subcommittee aimed to rate psychometric quality of severity and screening instruments for tics and related sensory phenomena. METHODS Following the methodology adopted by previous Movement Disorders Society subcommittee papers, a review of severity and screening instruments for tics was completed, applying a classification as "recommended," "suggested," or "listed" to each instrument. RESULTS A total of 5 severity scales (Yale Global Tic Severity Scale, Tourette Syndrome Clinical Global Impression, Tourette's Disorder Scale, Shapiro Tourette syndrome Severity Scale, Premonitory Urges for Tics Scale) were "recommended," and 6 (Rush Video-Based Tic Rating Scale, Motor tic, Obsessions and compulsions, Vocal tic Evaluation Survey, Tourette Syndrome Global Scale, Global Tic Rating Scale, Parent Tic Questionnaire, Tourette Syndrome Symptom List) were "suggested." A total of 2 screening instruments (Motor tic, Obsession and compulsions, Vocal tic Evaluation Survey and Autism-Tics, Attention Deficit/Hyperactivity Disorder and Other Comorbidities Inventory) were "recommended," whereas 2 others (Apter 4-questions screening and Proxy Report Questionnaire for Parents and Teachers) were "suggested." CONCLUSIONS Our review does not support the need for developing new tic severity or screening instruments. Potential objectives of future research include developing a rating instrument targeting the full spectrum of tic-related abnormal behaviors, assessing/screening malignant forms of tic disorders, and developing patient-reported outcome measures. © 2017 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Davide Martino
- International Parkinson's Centre of Excellence, King's College and King's College Hospital, London, UK.,Queen Elizabeth Hospital, Woolwich, Lewisham & Greenwich NHS Trust, London, UK
| | - Tamara M Pringsheim
- Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences, University of Calgary, Calgary, Canada
| | - Andrea E Cavanna
- Birmingham and Solihull Mental Health National Health Service Foundation Trust, Department of Neuropsychiatry, The Barberry National Centre for Mental Health, Birmingham, UK
| | - Carlo Colosimo
- Department of Neuroscience, University of Rome "La Sapienza,", Rome, Italy
| | - Andreas Hartmann
- Centre de Reference National Maladie Rare: "Syndrome Gilles de la Tourette," Departement de Neurologie, Pole des Maladies du Systeme Nerveux, Paris, France
| | - James F Leckman
- Child Study Center, Yale University, New Haven, Connecticut, USA
| | - Sheng Luo
- Department of Biostatistics, School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Alexander Munchau
- Department of Paediatric and Adult Movement Disorders and Neuropsychiatry, Institut of Neurogenetics, University of Lübeck, Lübeck, Germany
| | - Christopher G Goetz
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Ilinois, USA
| | - Glenn T Stebbins
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Ilinois, USA
| | - Pablo Martinez-Martin
- National Center of Epidemiology and Centro Investigación Biomédica en Red Enfermedades Neurodegenerativas, Carlos III Institute of Health, Madrid, Spain
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10
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Norén Selinus E, Molero Y, Lichtenstein P, Anckarsäter H, Lundström S, Bottai M, Hellner Gumpert C. Subthreshold and threshold attention deficit hyperactivity disorder symptoms in childhood: psychosocial outcomes in adolescence in boys and girls. Acta Psychiatr Scand 2016; 134:533-545. [PMID: 27714770 PMCID: PMC5129548 DOI: 10.1111/acps.12655] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/19/2016] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To examine the association between different levels of childhood attention deficit hyperactivity disorder (ADHD) symptoms and sex differences in psychosocial outcomes during adolescence. METHOD Swedish children (n = 4635) were screened for neuropsychiatric symptoms at age 9 or 12. ADHD symptoms were divided into three levels: screen-negative, screen-intermediate, and screen-positive. At follow-up (age 15), parents and teenagers filled out questionnaires regarding (i) hyperactivity/inattention, (ii) peer problems, (iii) school problems, (iv) internalizing problems, (v) antisocial behaviour, (vi) alcohol misuse, and (vii) drug misuse. All outcomes were controlled for symptoms of diagnostic categories other than ADHD. RESULTS Increasing levels of ADHD symptoms in childhood were associated with higher proportions of adolescents who displayed negative psychosocial outcomes. More girls than boys reported internalizing problems (all levels) and risky drug use (screen-intermediate and screen-positive only). More boys reported antisocial behaviour at the screen-negative and screen-intermediate levels, but at the screen-positive level, similar proportions of girls and boys displayed antisocial behaviour. CONCLUSION The findings support the view that ADHD symptoms, as well as their negative outcomes, are dimensionally distributed in the population and that adolescent girls and boys display different risk profiles. The findings confirm that ADHD symptoms are associated with higher risk of drug misuse in girls.
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Affiliation(s)
- E. Norén Selinus
- Department of Clinical NeuroscienceCentre for Psychiatry Research & EducationKarolinska Institutet & Stockholm County CouncilStockholmSweden
| | - Y. Molero
- Department of Clinical NeuroscienceCentre for Psychiatry Research & EducationKarolinska Institutet & Stockholm County CouncilStockholmSweden,Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
| | - P. Lichtenstein
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
| | - H. Anckarsäter
- Center for Ethics, Law and Mental Health (CELAM)University of GothenburgGöteborgSweden
| | - S. Lundström
- Center for Ethics, Law and Mental Health (CELAM)University of GothenburgGöteborgSweden,Gillberg Neuropsychiatry CentreUniversity of GothenburgGöteborgSweden
| | - M. Bottai
- Unit of BiostatisticsIMMKarolinska InstitutetStockholmSweden
| | - C. Hellner Gumpert
- Department of Clinical NeuroscienceCentre for Psychiatry Research & EducationKarolinska Institutet & Stockholm County CouncilStockholmSweden
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11
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Vachon MJ, Striley CW, Gordon MR, Schroeder ML, Bihun EC, Koller JM, Black KJ. VISIT-TS: A multimedia tool for population studies on tic disorders. F1000Res 2016; 5:1518. [PMID: 27853509 PMCID: PMC5089139 DOI: 10.12688/f1000research.7196.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/30/2016] [Indexed: 01/06/2023] Open
Abstract
Population-based assessment of Tourette syndrome (TS) and other tic disorders produces a paradox. On one hand, ideally diagnosis of tic disorders requires expert observation. In fact, diagnostic criteria for TS explicitly require expert assessment of tics for a definite diagnosis. On the other hand, large-scale population surveys with expert assessment of every subject are impracticable. True, several published studies have successfully used expert assessment to find tic prevalence in a representative population (e.g. all students in a school district). However, extending these studies to larger populations is daunting. We created a multimedia tool to demonstrate tics to a lay audience, discuss their defining and common attributes, and address features that differentiate tics from other movements and vocalizations. A first version was modified to improve clarity and to include a more diverse group in terms of age and ethnicity. The result is a tool intended for epidemiological research. It may also provide additional benefits, such as more representative minority recruitment for other TS studies and increased community awareness of TS.
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Affiliation(s)
- M Jonathan Vachon
- College of Arts and Sciences, Washington University in St. Louis, University City, USA
| | - Catherine W Striley
- Department of Epidemiology, Colleges of Medicine and Public Health & Health Professions, University of Florida, Gainesville, USA
| | - Mollie R Gordon
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, USA
| | | | - Emily C Bihun
- Department of Psychiatry, Washington University School of Medicine, St. Louis, USA
| | - Jonathan M Koller
- Department of Psychiatry, Washington University School of Medicine, St. Louis, USA
| | - Kevin J Black
- Departments of Psychiatry, Neurology, Radiology, and Neuroscience, Washington University School of Medicine, St. Louis, USA
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12
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Norén Selinus E, Molero Y, Lichtenstein P, Larson T, Lundström S, Anckarsäter H, Gumpert CH. Childhood Symptoms of ADHD Overrule Comorbidity in Relation to Psychosocial Outcome at Age 15: A Longitudinal Study. PLoS One 2015; 10:e0137475. [PMID: 26360378 PMCID: PMC4567137 DOI: 10.1371/journal.pone.0137475] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Accepted: 08/17/2015] [Indexed: 12/18/2022] Open
Abstract
Objective Neurodevelopmental problems (NDPs) may influence the transition from childhood to adolescence. Our aim was to study long-term psychosocial outcomes of NDPs, focusing on ADHD. Method Data was collected through a telephone interview with parents of twins at ages 9 or 12 years. NDP screen-positive children were clinically assessed at age 15; N = 450. Psychosocial outcome concerning peers, school, internalizing problems, antisocial behavior, alcohol misuse, drug misuse, and impaired daily functioning was examined. Results Even after controlling for other NDP comorbidity, screen-positivity for ADHD doubled or tripled the odds of later psychosocial problems. When controlling for parental education level, the significant effect of ADHD remained only for antisocial behavior and impaired daily functioning. Conclusions Signs of NDPs as well as other psychiatric diagnoses at ages 9 or 12 years are associated with a more problematic adolescence. However, despite the presence of comorbidity, early ADHD symptoms stand out as the most important risk factor for later antisocial development and impaired daily functioning.
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Affiliation(s)
- Eva Norén Selinus
- Department of Clinical Neuroscience, Centre for Psychiatry Research & Education, Karolinska Institutet & Stockholm County Council, Stockholm, Sweden
- * E-mail:
| | - Yasmina Molero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Tomas Larson
- Center for Ethics, Law and Mental Health (CELAM), University of Gothenburg, Göteborg, Sweden
| | - Sebastian Lundström
- Center for Ethics, Law and Mental Health (CELAM), University of Gothenburg, Göteborg, Sweden
- Gillberg Neuropsychiatry Centre, University of Gothenburg, Göteborg, Sweden
| | - Henrik Anckarsäter
- Center for Ethics, Law and Mental Health (CELAM), University of Gothenburg, Göteborg, Sweden
| | - Clara Hellner Gumpert
- Department of Clinical Neuroscience, Centre for Psychiatry Research & Education, Karolinska Institutet & Stockholm County Council, Stockholm, Sweden
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13
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Cubo E, Trejo J, Ausín V, Sáez S, Delgado V, Macarrón J, Cordero J, Louis ED, Kompoliti K, Benito-León J. Association of tic disorders with poor academic performance in central Spain: a population-based study. J Pediatr 2013; 163:217-23.e1-3. [PMID: 23351602 DOI: 10.1016/j.jpeds.2012.12.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Revised: 11/08/2012] [Accepted: 12/10/2012] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To analyze the association between tic disorders and poor academic performance in school-aged children. STUDY DESIGN This was a cross-sectional, observational study conducted in a randomly selected sample of mainstream school-aged children (aged 6-16 years). The sampling frame included different types of schools and educational levels. Children with poor academic performance (eg, repeating a grade, special needs), and tic disorders (defined based on Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision criteria) were identified. Children with and without tics and children with and without poor academic performance were compared in terms of clinical features (ie, medical history and neurologic and psychiatric comorbidities), school, and environmental characteristics. Logistic regression analyses were performed using school performance (dependent variable) and tic disorders (independent variable), after adjusting for confounding variables. RESULTS The study cohort comprised 1867 children (mean age, 10.9 + 2.9 years; 1007 males [53.9%]). Tics were present in 162 children (8.6%), and poor academic performance was noted in 223 (11.9%). Overall poor academic performance was associated with age (OR, 1.71; P < .0001), television viewing (OR, 5.33; P = .04), attention deficit hyperactivity disorder (OR, 1.38; P < .0001), and family history of school dysfunction (OR, 2.43; P = .02) and was negatively associated with higher IQ score (OR, 0.90; P < .0001) and tic disorders (OR, 0.29; P = .01). CONCLUSION After adjusting for other covariates, the presence of tic disorders was not associated with poor academic performance in our cohort. Early academic support and modification of environmental characteristics are needed for children at higher risk for school dysfunction, to enhance academic performance.
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Affiliation(s)
- Esther Cubo
- Department of Neurology, Yagüe General Hospital, Burgos, Spain.
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Cubo E. Review of prevalence studies of tic disorders: methodological caveats. Tremor Other Hyperkinet Mov (N Y) 2012; 2:tre-02-61-349-1. [PMID: 23440028 PMCID: PMC3569952 DOI: 10.7916/d8445k68] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Accepted: 11/10/2011] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Tic disorders are neurodevelopmental disorders of childhood associated with psychiatric comorbidity and academic problems. Estimating the prevalence and understanding the epidemiology of tic disorders is more complex than was once thought. Until fairly recently, tic disorders were thought to be rare, but today tics are believed to be the most common movement disorder, with 0.2-46.3% of schoolchildren experiencing tics during their lifetime. Tentative explanations for differing prevalence estimates include the multidimensional nature of tics with a varied and heterogeneous presentation, and the use of different epidemiological methods and study designs. METHODS Literature review and analysis of methodological issues pertinent to epidemiological studies of tic disorders. RESULTS Epidemiological studies of tic disorders were reviewed, and the main elements of epidemiological studies, including sample selection, case ascertainment strategy, definition of tic disorders, and the degree of coverage of the eligible population (i.e., the response rate) were examined. DISCUSSION In order to improve the quality of epidemiological studies of tic disorders, a number of recommendations were made, including but not limited to a review of the diagnostic criteria for tic disorders, and inclusion of new tic disorder categories for those with tics of secondary etiology.
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Affiliation(s)
- Esther Cubo
- Neurology Department, Complejo Asistencial Universitario de Burgos, Spain
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Louis ED, Cubo E, Trejo-Gabriel-Galán JM, Villaverde VA, Benito VD, Velasco SS, Vicente JM, Guevara JC, Benito-León J. Tremor in school-aged children: a cross-sectional study of tremor in 819 boys and girls in Burgos, Spain. Neuroepidemiology 2011; 37:90-5. [PMID: 21894047 DOI: 10.1159/000330352] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2011] [Accepted: 06/16/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Mild hand tremor occurs in most normal adults. There are no surveys of the prevalence or clinical correlates of such tremor among children. METHODS A cross-sectional study of tics, tremor and other neurological disorders was conducted in Spanish children; thus, 819 schoolchildren in Burgos, Spain, drew Archimedes spirals with each hand. Tremor in spirals was rated (0-2) by a blinded neurologist and an overall tremor rating (0-4) was assigned. RESULTS The mean age was 10.9 ± 3.1 years. A tremor rating of 1 (mild tremor) was present in either hand in 424 (51.7%) children, and in both hands in 88 (10.7%) children. Higher tremor ratings were very uncommon. The overall tremor rating was higher in boys than girls (1.31 ± 0.41 vs. 1.22 ± 0.34, p = 0.002) and correlated weakly yet significantly with age (ρ = 0.09, p = 0.01). Within subjects, the left hand spiral rating was greater than the right (p < 0.001). CONCLUSIONS In this cross-sectional study of 819 Spanish schoolchildren, mild tremor was commonly observed. As in adults, males had more tremor than females, tremor scores increased with age, and tremor scores were higher in the left than right arm, demonstrating that these clinical correlations seem to be more broadly generalizable to children. The functional significance of tremor in children, particularly as it relates to handwriting proficiency, deserves additional scrutiny.
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Affiliation(s)
- Elan D Louis
- GH Sergievsky Center, Columbia University, New York, NY, USA.
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Prevalence of tics in schoolchildren in central Spain: a population-based study. Pediatr Neurol 2011; 45:100-8. [PMID: 21763950 DOI: 10.1016/j.pediatrneurol.2011.03.003] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Accepted: 03/14/2011] [Indexed: 11/22/2022]
Abstract
Tic disorders constitute a neurodevelopmental disorder of childhood. This study sought to determine the prevalence of tic disorders in a school-based sample. A randomized sample of 1158 schoolchildren, based on clusters (classrooms) in the province of Burgos (Spain), was identified on a stratified sampling frame combining types of educational center and setting (mainstream schools and special education), using a two-phase approach (screening and diagnosis ascertainment by a neurologist). Tics with/without impairment criterion were diagnosed according to Diagnostic and Statistical Manual of Mental Disorders criteria. In mainstream schools, tics were observed in 125/741 students (16.86%; 95% confidence interval, 14.10-19.63), and were more frequent in boys (87/448, 19.42%; 95% confidence interval, 15.64-23.19) compared with girls (38/293, 12.96%; 95% confidence interval, 8.95-16.98; P = 0.03). In special education centers, tics disorders were observed in 11/54 of children (20.37%; 95% confidence interval, 8.70-32.03). Overall, tics with impairment criteria were less frequent than tics without impairment criteria (4.65% vs 11.85%, P < 0.0001). The most frequent diagnoses involved chronic motor tics (6.07%) and Tourette syndrome (5.26%). Tic disorders are common in childhood, and the use or nonuse of impairment criteria exerts a significant impact on tic prevalence estimates.
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