Risk Factors for Comorbidity in ADHD and GTS: Looking Beyond a Single-Deficit Model

Tourette's syndrome: challenging misconceptions and improving understanding

Tourette's syndrome affects about 1% of the school-age population. Children and young people with the condition exhibit involuntary motor and vocal (also known as phonic) tics. Only 10% of those with Tourette's syndrome have coprolalia, which involves involuntary swearing and inappropriate language. Tourette's syndrome often presents with other conditions such as obsessive-compulsive disorder, autism and attention deficit hyperactivity disorder. Those affected by Tourette's syndrome may be able to manage the condition with little or no professional support, but some may need pharmacological and nonpharmacological input, particularly from mental health services. It is essential that peers, teachers, healthcare staff and members of the public are aware of Tourette's syndrome to ensure that children and young people living with the condition are supported well.

Review: Physical exercise in Tourette syndrome - a systematic review

BACKGROUND

Tourette syndrome (TS) is a common neuropsychiatric disorder which, in addition to the core symptoms of motor and vocal tics, includes a high association with co-existing mental health disorders. Physical exercise is increasingly being recommended as part of management for children and young people with mental health problems. However, there is a lack of guidance regarding the role of physical exercise in the management of TS in children.

METHODS

EMBASE, MEDLINE, PsycINFO, SportDiscus, Google scholar and Cochrane register of controlled trials (CENTRAL) databases were searched. Studies investigating interventions aimed at reducing core symptoms of TS and comorbidities and exploring the relationship between physical exercise and tic severity were included.

RESULTS

Seven studies were identified. Five focused on physical exercise interventions and two were observational studies investigating the relationship between tic severity and physical activity. There was some evidence indicating that physical exercise reduces tic severity in the short term and some evidence regarding the benefit of physical exercise on associated co-occurring symptoms, such as anxiety. However, none of the intervention studies involved randomisation and interventions varied in terms of content and duration.

CONCLUSIONS

There was some evidence of a short-term improvement in tic expression as a result of physical exercise interventions, but there is a lack of methodologically robust studies. Thus, conclusions about the impact of exercise on TS symptoms or comorbidities cannot be drawn at this stage. There is a clear need for well-designed methodologically robust studies, including prospective observational studies and randomised controlled designs.

Tourette syndrome and comorbid conditions: a spectrum of different severities and complexities

To investigate clinical correlates of Tourette syndrome and to identify the impact of comorbidities, we retrospectively recruited 92 young people affected by Tourette syndrome compared with 102 healthy controls. Neuropsychological assessment included: Youth Quality of Life-Research, Multidimensional Anxiety Scale for Children, Children's Depression Inventory, and Conner's and Child Behavior Checklist; moreover, Tourette syndrome patients completed the Yale Global Tic Severity Rating Scale and the Yale-Brown Obsessive Compulsive Scale. Four clinical subgroups were identified: pure Tourette syndrome (49.8%), Tourette syndrome plus attention-deficit hyperactivity disorder (ADHD) (22.2%), Tourette syndrome plus obsessive-compulsive disorder (21.5%), and Tourette syndrome plus ADHD plus obsessive-compulsive disorder (6.5%). Our findings suggested that emotional lability appeared in all Tourette syndrome subgroups, independently from comorbidities, representing a clinical feature of Tourette syndrome itself. Moreover, our data suggested that all 4 clinical subgroups had higher statistically significant behavioral problems compared with the healthy controls (P = .000), whereas affective and anxiety symptoms were overrepresented in Tourette syndrome plus comorbidities subgroups. Finally, Tourette syndrome patients had a lower quality of life compared with the healthy controls. These differences were statistically significant between the pure Tourette syndrome subgroups and Tourette syndrome plus comorbidities subgroups, as well as Tourette syndrome plus comorbidities subgroups and healthy controls.

How does psychoeducation help? A review of the effects of providing information about Tourette syndrome and attention-deficit/hyperactivity disorder

Tourette syndrome (TS) and attention-deficit/hyperactivity disorder (ADHD) are common neurodevelopmental disorders that often co-occur. They are both stigmatized and misunderstood conditions. This review critically appraises studies examining interventions using psychoeducational approaches in TS and ADHD. Studies examining the impact of providing educational information (or diagnostic label) about TS and ADHD to parents, teachers and peers (child and adult) were identified by searching relevant electronic databases, reference lists and citations, and consulting colleagues. Twenty-two studies were identified, 20 of which involved teachers or peers. The studies indicate that providing educational information increases knowledge, positive attitudes and behaviours towards individuals with TS and ADHD. Provision of a diagnostic label alone appears insufficient. Parental education may improve treatment enrolment and adherence. While the findings are encouraging, there are a number of gaps in the literature. These include the effects of giving information to parents, whether changes are maintained over time, or are generalizable to the population. Studies are needed to investigate the optimal way to present educational information in everyday contexts in order to improve the lives of those with TS and ADHD.