Establishment of the reliability and validity of the Stress Index for Children or Adolescents with Tourette Syndrome (SICATS)

Psychosocial stress, self-esteem, and social adjustment: A moderated mediation analysis in Taiwanese adolescents with Tourette syndrome

PURPOSE

Recent studies have shown that tics and related comorbidities can cause poorer social adjustment, lower self-esteem, and higher psychosocial stress among adolescents with Tourette syndrome. This study explored the role of self-esteem in mediating the relationship between psychosocial stress and social adjustment among adolescents with Tourette syndrome, and the role of comorbidities in moderating the relationship between self-esteem and social adjustment.

DESIGN AND METHODS

In this descriptive cross-sectional study, 118 Taiwanese adolescents with Tourette syndrome aged between 12 and 20 years old were recruited via convenience sampling. Their demographic information, Yale Global Tic Severity Scale, stress index for children and adolescents with Tourette syndrome, social adjustment scale for adolescents with Tourette syndrome, and Self-Esteem Scale results were collected. Moderated mediation analysis of the study data was performed with the Hayes's PROCESS macro.

RESULTS

Our results revealed that the self-esteem of adolescents with Tourette syndrome fully mediates the relationship between their psychosocial stress and social adjustment (B = -0.0703, 95% CI, [-0.0176, -0.001]), while comorbidities moderates the relationship between their self-esteem and social adjustment (B = -0.8416, 95% CI, [-1.4529, -0.2302]). The relationship between self-esteem and social adjustment was more pronounced in adolescents without comorbidities than those with comorbidities.

CONCLUSIONS

Psychosocial stress correlates negatively with social adjustment and self-esteem, and indirectly influences social adjustment through self-esteem, while comorbidities (particularly their absence) moderates the relationship between self-esteem and social adjustment.

PRACTICE IMPLICATIONS

Different self-esteem strengthening programs to enhance social adjustment for adolescents with Tourette syndrome may be developed in future studies.

Development and Validation of the Social Adjustment Scale for Adolescents with Tourette Syndrome in Taiwan

PURPOSE

The aim of this study developed the psychometric properties of the social adjustment scale for adolescents with Tourette syndrome (SASATS).

DESIGN AND METHODS

A cross-sectional study design was conducted. 346 adolescents with Tourette syndrome (TS) were purposively sampled from pediatric outpatient departments at two hospitals in Taiwan. The scale was developed through a phenomenological study of adolescents with TS and by reviewing the literature. The reliability analysis of the SASATS was performed using the corrected item-total correlations coefficients, Cronbach alpha coefficients, and test-retest correlations. An exploratory factor analysis and confirmatory factor analysis were used to examine the construct validity.

RESULTS

The content validity index of 0.89 was obtained, and acceptable model fit was achieved according to the explanatory factor analysis and confirmatory factor analysis. The final scale had 17- items and four factors: relationship between self and TS, academic performance, family relationship, and peer interaction. Acceptable values of 0.81 and 0.87 were obtained for the test-retest and internal consistency reliabilities, respectively.

CONCLUSIONS

The SASATS is a reliable and valid instrument for evaluating social adjustment status in TS adolescents.

PRACTICE IMPLICATIONS

The SASATS is easy to use and offers an effective scale for nurses and healthcare providers in clinical and academic settings. It can quickly measure and detect the psychological functioning of the social adjustment of adolescents with TS during interpersonal interactions. Moreover, interventions can be provided to improve adolescents' social adjustment and promote their mental health.

The Modulating Role of Stress in the Onset and Course of Tourette’s Syndrome

Accumulating data indicate a common occurrence of tic exacerbations and periods of psychosocial stress. Patients with Tourette’s syndrome (TS) also exhibit aberrant markers of hypothalamic-pituitary-adrenal (HPA) axis activation. Based on these findings, a functional relationship between stress and tic disorders has been suggested, but the underlying mechanism of how stress may affect tic pathology remains to be elucidated. We suggest that dopaminergic and noradrenergic neurotransmission as well as immunology play a crucial role in mediating this relationship. Two possibilities of causal direction might be assumed: (a) psychosocial stress might lead to an exacerbation of tics via activation of HPA axis and subsequent changes in neurotransmission or immunology and (b) TS-related abnormalities in neurotransmission or immunology result in a higher vulnerability of affected patients to respond to psychosocial stress with a strong activation of the HPA axis. It may also be the case that both assumptions hold true and interact with each other.