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Soler N, Perkes IE, Dale RC, Bray P. Parent-young person lived experience of sensory dysregulation in children with tic disorders: a qualitative study. Disabil Rehabil 2024:1-19. [PMID: 39324587 DOI: 10.1080/09638288.2024.2403727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 09/06/2024] [Accepted: 09/07/2024] [Indexed: 09/27/2024]
Abstract
PURPOSE To understand the breadth of sensory dysregulation on participation in daily tasks for young people with tic disorders, as research identified that sensory dysregulation experiences are broader than the symptoms being assessed. METHODS Eighteen semi-structured interviews were conducted with 16 families with children (5-16 years) with tic disorders. Interviews ranged from 45 to 120 min and were transcribed verbatim. Data collected from parents and young people were analysed and coded together. Thematic analysis using inductive and open coding methods was implemented using NVivo. RESULTS The impact of sensory dysregulation on daily life may be understood through the higher-order theme: ''sensory, emotions and tics; it's a ticking time bomb'', and three subthemes: (1) we sacrifice and adapt to get daily activities done in the home, (2) my child's experience of the community environment hinders participation, and (3) sensory preferences impact our entire family. CONCLUSION Sensory dysregulation experiences impact the entire family's quality of life, yet patient-reported sensory measures do not adequately capture the impact on the family unit and breath of symptoms. A sensory-based measure for children with tics is needed to comprehensively assess sensory dysregulation sensitivities for this population, ensuring patients' needs and effectiveness of therapy can be measured.
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Affiliation(s)
- Nicolette Soler
- Department of Psychological Medicine, The Sydney Children's Hospitals Network, Sydney, Australia
- Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Iain E Perkes
- Department of Psychological Medicine, The Sydney Children's Hospitals Network, Sydney, Australia
- Discipline of Psychiatry & Mental Health and Discipline of Paediatrics & Children's Health, School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Kensington, Australia
- School of Women's and Children's Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| | - Russell C Dale
- Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Department of Paediatric Neurology, The Children's Hospital at Westmead, Sydney, Australia
- Kids Neuroscience Centre, and Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - Paula Bray
- The Sydney Children's Hospitals Network, Sydney, Australia and School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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2
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Atkinson-Clement C, Duflot M, Lastennet E, Patsalides L, Wasserman E, Sartoris TM, Tarrano C, Rosso C, Burbaud P, Deniau E, Czernecki V, Roze E, Hartmann A, Worbe Y. How does Tourette syndrome impact adolescents' daily living? A text mining study. Eur Child Adolesc Psychiatry 2023; 32:2623-2635. [PMID: 36460852 PMCID: PMC10682273 DOI: 10.1007/s00787-022-02116-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 11/21/2022] [Indexed: 12/03/2022]
Abstract
Tourette syndrome is a neurodevelopmental disease in which clinical manifestations are essentially present during childhood and adolescence, corresponding to one of the critical development phases. However, its consequences on the daily lives of young patients have been insufficiently investigated. Here, we aimed to investigate this using a statistical text mining approach, allowing for the analysis of a large volume of free textual data. Sixty-two adolescents with Tourette syndrome participated in an interview in which they discussed their daily life (i) in school, (ii) at home, and (iii) with strangers, (iv) the aspect of Tourette syndrome which caused the most difficulty, and (v) their thoughts regarding their future as adults. Following data pre-processing, these corpora were analyzed separately using the IRAMUTEQ software through factorial correspondence analysis to identify the most commonly recurring topics of each corpus, and their relations with clinical features. The main difficulty corpus was directly related to comorbidities of Tourette syndrome. Daily life at home was correlated with executive functioning. Difficulties at school were related to a higher severity of tics. Thoughts regarding future daily life were worst for the youngest patients and were correlated with executive functioning and a higher depression score. Taken altogether, our results highlighted that social stigma was a pervasive topic among our corpora. From a clinical standpoint, tic severity was especially related to difficulties at school, while comorbidities had a high impact on social daily living and cost for managing both tics and symptoms of comorbidities. TRIAL REGISTRATION: clinicaltrials.gov/ct2/show/NCT04179435.
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Affiliation(s)
- Cyril Atkinson-Clement
- Sorbonne Université, Paris Brain Institute Institut du Cerveau-ICM, CNRS, Hôpital de La Pitié Salpêtrière (DMU 6), InsermParis, AP-HP, France.
- Precision Imaging Beacon, School of Medicine, University of Nottingham, Nottingham, UK.
| | - Marion Duflot
- Sorbonne Université, Paris Brain Institute Institut du Cerveau-ICM, CNRS, Hôpital de La Pitié Salpêtrière (DMU 6), InsermParis, AP-HP, France
| | - Eloise Lastennet
- Sorbonne Université, Paris Brain Institute Institut du Cerveau-ICM, CNRS, Hôpital de La Pitié Salpêtrière (DMU 6), InsermParis, AP-HP, France
| | - Leïla Patsalides
- Sorbonne Université, Paris Brain Institute Institut du Cerveau-ICM, CNRS, Hôpital de La Pitié Salpêtrière (DMU 6), InsermParis, AP-HP, France
| | - Emma Wasserman
- Sorbonne Université, Paris Brain Institute Institut du Cerveau-ICM, CNRS, Hôpital de La Pitié Salpêtrière (DMU 6), InsermParis, AP-HP, France
| | - Therese-Marie Sartoris
- Sorbonne Université, Paris Brain Institute Institut du Cerveau-ICM, CNRS, Hôpital de La Pitié Salpêtrière (DMU 6), InsermParis, AP-HP, France
| | - Clément Tarrano
- Sorbonne Université, Paris Brain Institute Institut du Cerveau-ICM, CNRS, Hôpital de La Pitié Salpêtrière (DMU 6), InsermParis, AP-HP, France
| | - Charlotte Rosso
- Sorbonne Université, Paris Brain Institute Institut du Cerveau-ICM, CNRS, Hôpital de La Pitié Salpêtrière (DMU 6), InsermParis, AP-HP, France
- Urgences Cérébro-Vasculaires, Pitié-Salpétrière Hospital, Paris, France
| | - Pierre Burbaud
- Centre Hospitalier Universitaire de Bordeaux, Institut des Maladies Neurodégénératives, CNRS, University of Bordeaux, Bordeaux, France
| | - Emmanuelle Deniau
- Sorbonne Université, Paris Brain Institute Institut du Cerveau-ICM, CNRS, Hôpital de La Pitié Salpêtrière (DMU 6), InsermParis, AP-HP, France
- National Reference Center for Tourette Syndrome, Assistance Publique des Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, 75013, Paris, France
| | - Virginie Czernecki
- Sorbonne Université, Paris Brain Institute Institut du Cerveau-ICM, CNRS, Hôpital de La Pitié Salpêtrière (DMU 6), InsermParis, AP-HP, France
- National Reference Center for Tourette Syndrome, Assistance Publique des Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, 75013, Paris, France
| | - Emmanuel Roze
- Sorbonne Université, Paris Brain Institute Institut du Cerveau-ICM, CNRS, Hôpital de La Pitié Salpêtrière (DMU 6), InsermParis, AP-HP, France
| | - Andreas Hartmann
- Sorbonne Université, Paris Brain Institute Institut du Cerveau-ICM, CNRS, Hôpital de La Pitié Salpêtrière (DMU 6), InsermParis, AP-HP, France
- National Reference Center for Tourette Syndrome, Assistance Publique des Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, 75013, Paris, France
| | - Yulia Worbe
- Sorbonne Université, Paris Brain Institute Institut du Cerveau-ICM, CNRS, Hôpital de La Pitié Salpêtrière (DMU 6), InsermParis, AP-HP, France
- National Reference Center for Tourette Syndrome, Assistance Publique des Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, 75013, Paris, France
- Department of Neurophysiology, Saint Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
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3
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Jalenques I, Guiguet-Auclair C, Cyrille D, Debosque C, Derost P, Hartmann A, Lauron S, Jameux C, Tauveron—Jalenques U, Rondepierre F. The French version of the Gilles de la Tourette Syndrome Quality of Life Scale for adolescents (GTS-QOL-French-Ado): Adaptation and psychometric evaluation. PLoS One 2022; 17:e0278383. [PMID: 36449509 PMCID: PMC9710837 DOI: 10.1371/journal.pone.0278383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 11/15/2022] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION The aim of this study was to create a new version of the French GTS-QOL adapted to adolescents with GTS aged 12-16 years (GTS-QOL-French-Ado) and to evaluate its psychometric properties. METHODS We assessed the psychometric properties of the GTS-QOL-French-Ado in 84 adolescents (mean age 13.6 years, standard deviation 1.2) in terms of factor structure, internal consistency, reliability and convergent validity with the Child Depression Inventory (CDI), the Multidimensional Anxiety Scale for Children (MASC), the Motor tic, Obsessions and compulsions, Vocal tic Evaluation Survey (MOVES) and the French "Vécu et Santé Perçue de l'Adolescent" (VSP-A), a generic self-administered measure of health-related quality of life (HRQoL) in adolescents. RESULTS Exploratory factor analysis of the GTS-QOL-French-Ado resulted in a 5-factor solution. The GTS-QOL-French-Ado demonstrated good acceptability with missing values per subscale ranging from 0% to 1.2%, good internal consistency for four of the five subscales with Cronbach's alpha ranging from 0.56 to 0.87 and good test-retest reliability with intraclass correlation coefficients ranging from 0.74 (95% CI: 0.52-0.86) to 0.82 (95% CI: 0.66-0.91). Convergent validity was supported by correlations with CDI, MASC, MOVES, VSP-A and clinical variables. DISCUSSION The GTS-QOL-French-Ado is the first disease-specific HRQoL tool for French-speaking adolescents with GTS aged 12-16 years, and shows good psychometric properties. Further psychometric testing on responsiveness to change would be of great interest.
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Affiliation(s)
- Isabelle Jalenques
- Service de Psychiatrie de l’Adulte A et Psychologie Médicale, Centre de Compétence Gilles de la Tourette, CNRS, Institut Pascal, CHU Clermont-Ferrand, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Candy Guiguet-Auclair
- CNRS, Institut Pascal, CHU Clermont-Ferrand, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Diane Cyrille
- Service de Psychiatrie de l’Adulte A et Psychologie Médicale, CNRS, Institut Pascal, CHU Clermont-Ferrand, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Clement Debosque
- Service de Psychiatrie de l’Adulte A et Psychologie Médicale, CNRS, Institut Pascal, CHU Clermont-Ferrand, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Philippe Derost
- Service de Neurologie, CHU Clermont-Ferrand, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Andreas Hartmann
- Department of Neurology, National Reference Center for Tourette Syndrome, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Sophie Lauron
- Service de Psychiatrie de l’Adulte A et Psychologie Médicale, CNRS, Institut Pascal, CHU Clermont-Ferrand, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Clara Jameux
- Service de Psychiatrie de l’Adulte A et Psychologie Médicale, CNRS, Institut Pascal, CHU Clermont-Ferrand, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Urbain Tauveron—Jalenques
- Service de Psychiatrie de l’Adulte A et Psychologie Médicale, CNRS, Institut Pascal, CHU Clermont-Ferrand, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Fabien Rondepierre
- Service de Psychiatrie de l’Adulte A et Psychologie Médicale, Centre de Compétence Gilles de la Tourette, CNRS, Institut Pascal, CHU Clermont-Ferrand, Université Clermont Auvergne, Clermont-Ferrand, France
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4
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Abstract
Tourette syndrome (TS) causes academic, social, emotional, physical, and functional problems. Most TS patients also have comorbid neuropsychological conditions. The purpose of this review is to provide updated information to the clinician about phenomenology, epidemiology, comorbidities, pathophysiology and management strategies for tics (a hallmark of TS) and TS. Recent findings suggest that TS is likely due to a combination of several different genes and environmental factors, with possible involvement of the cortical-basal ganglia-thalamocortical circuit and related multiple neurotransmitters. First-line management includes psychoeducation for families, patients, and school personnel, as well as behavioral therapy. Non-medicine treatment for tics is advancing to include younger children and increase access via remote service applications. Pharmacotherapy is used if appropriate and several new medicines are under investigation (e.g., Tetrabenazine, valbenazine, deutetrabenazine, ecopipam, cannabinoids). Deep brain stimulation and Mouthguard therapy can be used for children with intractable illness.
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Affiliation(s)
- Kallol K Set
- Pediatric Neurologist, Dayton Children's Hospital, Clinical Assistant Professor, Pediatrics, Boonshoft School of Medicine, Wright State University, One Children's Plaza, Dayton, Ohio, 45404-1815, USA.
| | - Jacqueline N Warner
- Pediatric Psychologist, Clinical Assistant Professor, Pediatrics. Boonshoft School of Medicine, Wright State University, Dayton Children's Hospital, One Children's Plaza, Dayton, Ohio, 45404-1815, USA.
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5
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Garris JF, Huddleston DA, Jackson HS, Horn PS, Gilbert DL. Implementation of the Mini-Child Tourette Syndrome Impairment Scale: Relationships to Symptom Severity and Treatment Decisions. J Child Neurol 2021; 36:288-295. [PMID: 33124927 PMCID: PMC7855018 DOI: 10.1177/0883073820967518] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Functional impairment is an important factor in Tic Disorder treatment decisions. We evaluated the mini Child Tourette Syndrome Impairment Scale (mini-CTIM) for correlation with symptom severity and association with interventions. A total of 61 randomly selected tic encounters were retrospectively analyzed for mini-CTIM correlation with symptom severity scores and compared between patients who received treatment and those who did not. Regression models identified factors associated with treatment decisions. Mini-CTIM-tic scores correlated with tic severity and mini-CTIM-non-tic scores correlated with attention-deficit hyperactivity disorder (ADHD) severity. Tic treatment was associated with higher child, but not parent, mini-CTIM-tic scores. Regression models identified that comorbidity treatment was predicted by ADHD severity, obsessive compulsive disorder severity, and parent but not child mini-CTIM-non-tic scores. These findings suggest children have valuable insight into their tic-related impairment, but parent assessment is important for evaluating comorbidity-related impairment. The mini-CTIM may be a useful clinical tool for assessing tic-related impairment.
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Affiliation(s)
- Jordan F Garris
- Cincinnati Children’s Hospital, Department of Neurology, 3333 Burnet Avenue, Cincinnati, OH 45229,University of Cincinnati College of Medicine, Department of Pediatrics, 3235 Eden Avenue, Cincinnati, Ohio, 45267,University of Virginia, Department of Neurology, 1415 Jefferson Avenue, Charlottesville, VA 22903
| | - David A Huddleston
- Cincinnati Children’s Hospital, Department of Neurology, 3333 Burnet Avenue, Cincinnati, OH 45229
| | - Hannah S Jackson
- Cincinnati Children’s Hospital, Department of Neurology, 3333 Burnet Avenue, Cincinnati, OH 45229
| | - Paul S Horn
- Cincinnati Children’s Hospital, Department of Neurology, 3333 Burnet Avenue, Cincinnati, OH 45229,University of Cincinnati College of Medicine, Department of Pediatrics, 3235 Eden Avenue, Cincinnati, Ohio, 45267
| | - Donald L Gilbert
- Cincinnati Children’s Hospital, Department of Neurology, 3333 Burnet Avenue, Cincinnati, OH 45229,University of Cincinnati College of Medicine, Department of Pediatrics, 3235 Eden Avenue, Cincinnati, Ohio, 45267
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6
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Park EG, Kim YH. Clinical features and neuropsychiatric comorbidities in pediatric patients with tic disorders: a retrospective chart review study from South Korea. BMC Psychiatry 2021; 21:14. [PMID: 33413251 PMCID: PMC7791808 DOI: 10.1186/s12888-020-03014-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 12/14/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Tic disorders are childhood-onset neuropsychiatric disorders characterized by multiple motor or vocal tics with frequent comorbidities and a broad spectrum of phenotypic presentations. In this study, we aimed to investigate the clinical characteristics and comorbid neuropsychiatric conditions in pediatric patients with tic disorders. METHODS We retrospectively reviewed the medical records of 119 pediatric patients (89 males, 30 females) who were diagnosed with tic disorders according to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) at Uijeongbu St. Mary's Hospital, Republic of Korea, between January 2012 and July 2019. RESULTS The mean age of tic onset was 6.9 years (range, 1-14) and the mean age at diagnosis was 8 years (range, 1-17). The mean lag between tic onset and diagnosis was 13.3 months (range, 0.25-132). The most common, first-presenting tics were eye blinking (50.4%), followed by jaw or lip movement (29.4%) and throat clearing (29.4%). Thirty-seven (31.1%) patients had at least one co-occurring neuropsychiatric disorder at the time of tic diagnosis. Subtypes of tic disorders, types of initial tics, and presence of neuropsychiatric comorbidities were not associated with tic severity. Tic severity was associated with greater functional impairment and tic noticeability (p < 0.05). A relatively shorter time to diagnosis was associated with tic severity (Spearman's ρ = - 0.14, p = 0.11). CONCLUSIONS The evolving nature of tic expression and severity, high prevalence of neuropsychiatric comorbidities, and associated functional impairments emphasize the importance of comprehensive assessment during the disease course for determining and prioritizing goals of treatment.
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Affiliation(s)
- Eu Gene Park
- grid.411947.e0000 0004 0470 4224Department of Pediatrics, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 56, Dongsu-ro, Bupyeong-gu, Incheon, 21431 Republic of Korea
| | - Young-Hoon Kim
- Department of Pediatrics, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 271, Cheonbo-ro, Uijeongbu-si, Gyeonggi-do, 11765, Republic of Korea.
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7
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Treatment use among children with Tourette syndrome living in the United States, 2014. Psychiatry Res 2020; 293:113400. [PMID: 32841891 PMCID: PMC7669536 DOI: 10.1016/j.psychres.2020.113400] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/13/2020] [Accepted: 08/17/2020] [Indexed: 01/06/2023]
Abstract
Treatment of Tourette syndrome (TS) can be complicated by changes over time in tic expression, severity, and co-occurring disorders. Using the 2014 National Survey of the Diagnosis and Treatment of ADHD and Tourette Syndrome, this study provides descriptive estimates of the use of behavioral interventions and medication among children living with TS. Parent-reported data on 115 children aged 5-17 years ever diagnosed with TS were analyzed to provide descriptive, unweighted results. Overall, 77.4% of children had current or past use of any TS treatment; 59.1% ever used behavioral interventions and 56.1% had ever taken TS medication. Children with "moderate" or "severe" versus "mild" TS, ≥1 co-occurring disorders, and tics that interfered with functioning were significantly more likely to have used one or more TS treatments. Side effects were reported for 84.4% of children who took TS medication. Most parents of children with current TS (87.2%) were satisfied with the management of their child's TS. However, parents of children with "moderate" or "severe" current TS were significantly more dissatisfied compared to parents of children with "mild" TS. Findings from this study could be used to inform efforts to support children living with TS and their families.
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8
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Quast LF, Rosenthal LD, Cushman GK, Gutiérrez-Colina AM, Braley EI, Kardon P, Blount RL. Relations Between Tic Severity, Emotion Regulation, and Social Outcomes in Youth with Tourette Syndrome. Child Psychiatry Hum Dev 2020; 51:366-376. [PMID: 31863267 DOI: 10.1007/s10578-019-00948-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 12/07/2019] [Accepted: 12/10/2019] [Indexed: 12/01/2022]
Abstract
This study examined associations between tic severity, emotion regulation, social functioning, and social impairment in youth with Tourette Syndrome (TS). Emotion regulation was examined as a mediator between tic severity and social outcomes. Seventy-seven caregivers of youth with TS (M age = 13.1 years; SD = 2.29) were administered proxy-report measures of tic severity, emotion regulation, social functioning, and social impairment. Total and motor tic severity were negatively associated with emotion regulation and social functioning, and positively associated with social impairment (r's = 0.23 to 0.43). Vocal tic severity was not related to emotion regulation or social functioning, but was positively associated with social impairment (r = 0.36). Emotion regulation mediated the relations between total tic severity and both social outcomes, and motor tic severity and both social outcomes. Interventions that target emotion regulation would likely be a beneficial adjunctive therapy for youth with TS, and may result in improved social outcomes.
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Affiliation(s)
- Lauren F Quast
- Department of Psychology, University of Georgia, 125 Baldwin St., Athens, GA, 30602, USA.
| | - Lindsay D Rosenthal
- Department of Psychology, University of Georgia, 125 Baldwin St., Athens, GA, 30602, USA
| | - Grace K Cushman
- Department of Psychology, University of Georgia, 125 Baldwin St., Athens, GA, 30602, USA
| | - Ana M Gutiérrez-Colina
- Department of Psychology, University of Georgia, 125 Baldwin St., Athens, GA, 30602, USA
| | - Emily I Braley
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
| | - Patricia Kardon
- Tourette Information Center and Support (TICS) of Georgia, Inc., Atlanta, GA, USA
| | - Ronald L Blount
- Department of Psychology, University of Georgia, 125 Baldwin St., Athens, GA, 30602, USA
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9
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Kano Y, Fujio M, Kaji N, Matsuda N, Nonaka M, Kono T. Changes in Sensory Phenomena, Tics, Obsessive-Compulsive Symptoms, and Global Functioning of Tourette Syndrome: A Follow-Up After Four Years. Front Psychiatry 2020; 11:619. [PMID: 32695033 PMCID: PMC7338586 DOI: 10.3389/fpsyt.2020.00619] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 06/15/2020] [Indexed: 11/13/2022] Open
Abstract
Sensory phenomena and related features of Tourette syndrome are related to poorer quality of life. Therefore, sensory phenomena might also have a negative impact on global functioning. However, the influence of sensory phenomena, tics, and obsessive-compulsive symptoms (OCS) on global functioning after several years of usual treatment has not been investigated. Twenty out of 45 Japanese patients with Tourette syndrome who had previously undergone an evaluation of these clinical features were assessed again after an average of four years. We conducted a panel of assessments for premonitory urges, broader sensory phenomena, tic severity, OCS, and global functioning. Based on Pearson's correlation coefficient, current global functioning was significantly negatively correlated with previous tics and marginally negatively correlated with previous broader sensory phenomena. Current global functioning was marginally correlated with change in tics. Change in global functioning was significantly correlated with change in OCS and marginally correlated with change in premonitory urges. Due to the small sample size, it was not possible to use a multiple regression analysis to conclude that sensory phenomena, tics, and OCS predict global functioning in adolescents and adults with TS. However, it was suggested that further investigation of this relationship would be meaningful.
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Affiliation(s)
- Yukiko Kano
- Department of Child Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Child Psychiatry, The University of Tokyo Hospital, Tokyo, Japan
| | - Miyuki Fujio
- Department of Child Psychiatry, The University of Tokyo Hospital, Tokyo, Japan.,Course of Clinical Psychology, Graduate School of Education, The University of Tokyo, Tokyo, Japan.,Department of Psychology, Faculty of Liberal Arts, Teikyo University, Tokyo, Japan
| | - Namiko Kaji
- Department of Child Psychiatry, The University of Tokyo Hospital, Tokyo, Japan.,Office for Mental Health Support, Division for Counseling and Support, The University of Tokyo, Tokyo, Japan
| | - Natsumi Matsuda
- Department of Child Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Child Psychiatry, The University of Tokyo Hospital, Tokyo, Japan.,Department of Developmental Psychology, Faculty of Human Studies, Shirayuri University, Tokyo, Japan
| | - Maiko Nonaka
- Department of Child Psychiatry, The University of Tokyo Hospital, Tokyo, Japan.,Course of Clinical Psychology, Graduate School of Education, The University of Tokyo, Tokyo, Japan
| | - Toshiaki Kono
- Department of Child Psychiatry, The University of Tokyo Hospital, Tokyo, Japan.,Department of Community Mental Health and Law, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
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10
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Soler N, Hardwick C, Perkes IE, Mohammad SS, Dossetor D, Nunn K, Bray P, Dale RC. Sensory dysregulation in tic disorders is associated with executive dysfunction and comorbidities. Mov Disord 2019; 34:1901-1909. [PMID: 31505086 DOI: 10.1002/mds.27817] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 07/04/2019] [Accepted: 07/19/2019] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Tics are conceptualized as a sensorimotor phenomenon with a premonitory urge typically described by patients. As observed in other neurodevelopmental disorders, we have observed sensory dysregulation symptoms, such as tactile hypersensitivity to clothing, in children with tic disorders; however, formal clinical research in this area is limited. OBJECTIVE To define the presence of sensory dysregulation symptoms in tic disorders, and their clinical associations. METHODS Prevalence of sensory dysregulation in 102 children with tic disorders was compared to 61 age- and sex-matched healthy controls. Sensory dysregulation, executive function, and quality of life data were obtained through the Short Sensory Profile-2, Sensory Profile-2, Sensory Processing Measure, Behaviour Rating Inventory of Executive Function-2, and Strength and Difficulties Questionnaire and Pediatric Quality of Life Inventory. Tics were assessed with the Yale Global Tic Severity Scale. RESULTS Children with tics, in the presence of comorbidity, had elevated sensory dysregulation compared to healthy controls (P < 0.001). There was a positive correlation between sensory dysregulation and global executive difficulties in children with tics and comorbidity (n = 87; rho = 0.716; P < 0.001) and a negative correlation of sensory dysregulation with quality of life (n = 87; rho = -0.595; P < 0.001). In children with tics, there was an association between sensory dysregulation and number of comorbidities (P < 0.001). CONCLUSION In the presence of comorbidity, children with tic disorders have broad sensory dysregulation symptoms beyond the premonitory urge. There was a statistically significant association between sensory dysregulation and executive function difficulties and the presence of neurodevelopmental and psychiatric comorbidity. Sensory dysregulation can be considered neurodevelopmental symptoms, providing insight into the neurobiology of tics and opportunities for therapeutic intervention. © 2019 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Nicolette Soler
- Department of Psychological Medicine, The Children's Hospital at Westmead, Sydney, Australia.,Faculty of Medicine and Health, The University of Sydney, Children's Hospital Westmead Clinical School, Sydney, Australia
| | - Chris Hardwick
- Department of Psychological Medicine, The Children's Hospital at Westmead, Sydney, Australia
| | - Iain E Perkes
- Department of Psychological Medicine, The Children's Hospital at Westmead, Sydney, Australia.,Faculty of Medicine and Health, The University of Sydney, Children's Hospital Westmead Clinical School, Sydney, Australia.,The University of New South Wales, School of Psychiatry, Faculty of Medicine, & School of Psychology, Faculty of Science, Sydney, Australia
| | - Shekeeb S Mohammad
- Department of Pediatric Neurology, The Children's Hospital at Westmead, Sydney, Australia.,Faculty of Medicine and Health, The University of Sydney, Children's Hospital Westmead Clinical School, Sydney, Australia
| | - David Dossetor
- Department of Psychological Medicine, The Children's Hospital at Westmead, Sydney, Australia.,Faculty of Medicine and Health, The University of Sydney, Children's Hospital Westmead Clinical School, Sydney, Australia
| | - Kenneth Nunn
- Department of Psychological Medicine, The Children's Hospital at Westmead, Sydney, Australia.,Faculty of Medicine and Health, The University of Sydney, Children's Hospital Westmead Clinical School, Sydney, Australia
| | - Paula Bray
- The University of Sydney, Faculty of Health Sciences, Sydney, Australia
| | - Russell C Dale
- Department of Pediatric Neurology, The Children's Hospital at Westmead, Sydney, Australia.,Faculty of Medicine and Health, The University of Sydney, Children's Hospital Westmead Clinical School, Sydney, Australia.,Kids Neuroscience Centre, and Brain and Mind Centre, Sydney, Australia
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11
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Dang TTH, Rowell D, Liddle J, Coyne T, Silburn P, Connelly LB. Economic evaluation of deep-brain stimulation for Tourette's syndrome: an initial exploration. J Neurol 2019; 266:2997-3008. [PMID: 31485722 DOI: 10.1007/s00415-019-09521-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 08/26/2019] [Accepted: 08/28/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Deep-brain stimulation (DBS) can be effective in controlling medically intractable symptoms of Tourette's syndrome (TS). There is no evidence to date, though, of the potential cost-effectiveness of DBS for this indication. OBJECTIVE To provide the first estimates of the likely cost-effectiveness of DBS in the treatment of severe TS. METHODS We conducted a cost-utility analysis using clinical data from 17 Australian patients receiving DBS. Direct medical costs for DBS using non-rechargeable and rechargeable batteries and for the alternative best medical treatment (BMT), and health utilities for BMT were sourced from the literature. Incremental cost-effectiveness ratios (ICERs) were estimated using a Markov models with a 10-year time horizon and 5% discount rate. RESULTS DBS increased quality-adjusted life year (QALY) gained from 2.76 to 4.60 over a 10-year time horizon. The ICER for DBS with non-rechargeable (rechargeable) batteries, compared to BMT, was A$33,838 (A$15,859) per QALY. The ICER estimates are sensitive to DBS costs and selected time horizon. CONCLUSIONS Our study indicates that DBS may be a cost-effective treatment for severe TS, based on the very limited clinical data available and under particular assumptions. While the limited availability of data presents a challenge, we also conduct sensitivity analyses to test the robustness of the results to the assumptions used in the analysis. We nevertheless recommend the implementation of randomised controlled trials that collect a comprehensive range of costs and the use of a widely accepted health-related quality of life instrument to enable more definitive statements about the cost-effectiveness of DBS for TS.
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Affiliation(s)
- Tho T H Dang
- Asia-Pacific Centre for Neuromodulation, Queensland Brain Institute, The University of Queensland, Brisbane, Australia. .,Centre for the Business and Economics of Health, The University of Queensland, Brisbane, Australia.
| | - David Rowell
- Centre for the Business and Economics of Health, The University of Queensland, Brisbane, Australia
| | - Jacki Liddle
- School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia
| | - Terry Coyne
- Asia-Pacific Centre for Neuromodulation, Queensland Brain Institute, The University of Queensland, Brisbane, Australia
| | - Peter Silburn
- Asia-Pacific Centre for Neuromodulation, Queensland Brain Institute, The University of Queensland, Brisbane, Australia
| | - Luke B Connelly
- Asia-Pacific Centre for Neuromodulation, Queensland Brain Institute, The University of Queensland, Brisbane, Australia.,Centre for the Business and Economics of Health, The University of Queensland, Brisbane, Australia.,Dipartimento di Sociologia e Diritto dell'Economia, The University of Bologna, Bologna, Italy
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12
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Children with Tourette Syndrome in the United States: Parent-Reported Diagnosis, Co-Occurring Disorders, Severity, and Influence of Activities on Tics. J Dev Behav Pediatr 2019; 40:407-414. [PMID: 31318778 PMCID: PMC6707080 DOI: 10.1097/dbp.0000000000000667] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Describe the diagnostic process for Tourette syndrome (TS) based on parent report, as well as TS severity and associated impairment; the influence of common daily activities on tics; and the presence of co-occurring mental, behavioral, and developmental disorders among children in the United States. METHODS Parent-report data from the 2014 National Survey of the Diagnosis and Treatment of ADHD and Tourette Syndrome on 115 children ever diagnosed with TS were analyzed. Descriptive, unweighted analyses included frequencies and percentages, and means and standard deviations. Fisher's exact test and t-tests were calculated to determine statistically significant differences. RESULTS The mean age that tics were first noticed was 6.3 years, and, on average, TS was diagnosed at 7.7 years. The time from initially noticing tics to TS diagnosis averaged 1.7 years. The mean age when TS symptoms were most severe was 9.3 years. Tic severity was associated with impaired child functioning but not tic noticeability. Almost 70% of parents reported that fatigue and major transitions made their child's tics worse. Children with ever-diagnosed TS had a mean of 3.2 ever-diagnosed co-occurring mental, behavioral, or developmental disorders; a quarter (26.9%) had 5 or more co-occurring disorders. DISCUSSION In this sample of children with TS, the time to diagnosis averaged less than 2 years from when tics were initially noticed. More severe TS was associated with greater functional impairment, and co-occurring disorders were common among children with TS. This study provides insight into the current experiences of children with TS in the United States and their families.
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13
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Karras HC, Morin DN, Gill K, Izadi-Najafabadi S, Zwicker JG. Health-related quality of life of children with Developmental Coordination Disorder. RESEARCH IN DEVELOPMENTAL DISABILITIES 2019; 84:85-95. [PMID: 29907374 DOI: 10.1016/j.ridd.2018.05.012] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 05/05/2018] [Accepted: 05/20/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Although Developmental Coordination Disorder (DCD) is primarily a motor disorder, it can also impact emotional and psychosocial functioning of children with this condition. Evidence suggests that children with DCD experience lower quality of life than their peers, but few studies have explicitly examined the health-related quality of life (HRQOL) of these children. AIMS To: (1) describe HRQOL of children with DCD compared to typically-developing children; (2) compare HRQOL from the perspectives of children with DCD and their parents; and (3) explore predictors of HRQOL for children with DCD. METHODS Data from the KidScreen-52 and Strength and Difficulties Questionnaire were collected from 50 children with DCD [Mean(SD) age: 9.8 (1.2) years] and their parents and compared to normative data. RESULTS Children with DCD and their parents report significantly lower HRQOL compared to published norms. Caregivers have a significantly lower perception of their child's HRQOL than their child's self-report in many domains. Parents of children with DCD report that their children experience significantly more emotional and behavioral disturbances compared to norms. Poor motor function and attentional difficulties predict HRQOL. CONCLUSION AND IMPLICATIONS DCD appears to contribute to lower perceived HRQOL. Findings inform therapeutic targets for children with DCD, beyond motor skill intervention.
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Affiliation(s)
- Heather C Karras
- Department of Occupational Science & Occupational Therapy, University of British Columbia, Vancouver, Canada
| | - Danita N Morin
- Department of Occupational Science & Occupational Therapy, University of British Columbia, Vancouver, Canada
| | - Kamaldeep Gill
- Graduate Programs in Rehabilitation Science, University of British Columbia, Vancouver, Canada; BC Children's Hospital Research Institute, Vancouver, Canada
| | - Sara Izadi-Najafabadi
- Graduate Programs in Rehabilitation Science, University of British Columbia, Vancouver, Canada; BC Children's Hospital Research Institute, Vancouver, Canada
| | - Jill G Zwicker
- Department of Occupational Science & Occupational Therapy, University of British Columbia, Vancouver, Canada; BC Children's Hospital Research Institute, Vancouver, Canada; Department of Pediatrics, University of British Columbia, Vancouver, Canada; Sunny Hill Health Centre for Children, Vancouver, Canada; CanChild Centre for Childhood Disability Research, Hamilton, Canada.
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14
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Stiede JT, Alexander JR, Wellen B, Bauer CC, Himle MB, Mouton-Odum S, Woods DW. Differentiating tic-related from non-tic-related impairment in children with persistent tic disorders. Compr Psychiatry 2018; 87:38-45. [PMID: 30195099 PMCID: PMC6240497 DOI: 10.1016/j.comppsych.2018.07.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 07/23/2018] [Accepted: 07/24/2018] [Indexed: 11/20/2022] Open
Abstract
Children with persistent (chronic) tic disorders (PTDs) experience impairment across multiple domains of functioning, but given high rates of other non-tic-related conditions, it is often difficult to differentiate the extent to which such impairment is related to tics or to other problems. The current study used the Child Tourette's Syndrome Impairment Scale - Parent Report (CTIM-P) to examine parents' attributions of their child's impairment in home, school, and social domains in a sample of 58 children with PTD. Each domain was rated on the extent to which the parents perceived that impairment was related to tics versus non-tic-related concerns. In addition, the Yale Global Tic Severity Scale (YGTSS) was used to explore the relationship between tic-related impairment and tic severity. Results showed impairment in school and social activities was not differentially attributed to tics versus non-tic-related impairment, but impairment in home activities was attributed more to non-tic-related concerns than tics themselves. Moreover, tic severity was significantly correlated with tic-related impairment in home, school, and social activities, and when the dimensions of tic severity were explored, impairment correlated most strongly with motor tic complexity. Results suggest that differentiating tic-related from non-tic-related impairment may be clinically beneficial and could lead to treatments that more effectively target problems experienced by children with PTDs.
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Affiliation(s)
- Jordan T Stiede
- Marquette University, 604 N. 16th St., Milwaukee, WI 53233, United States of America
| | - Jennifer R Alexander
- Marquette University, 604 N. 16th St., Milwaukee, WI 53233, United States of America
| | - Brianna Wellen
- University of Utah, 201 Presidents Cir., Salt Lake City, UT 84112, United States of America
| | - Christopher C Bauer
- Marquette University, 604 N. 16th St., Milwaukee, WI 53233, United States of America
| | - Michael B Himle
- University of Utah, 201 Presidents Cir., Salt Lake City, UT 84112, United States of America
| | - Suzanne Mouton-Odum
- Psychology Houston, PC, 7660 Woodway, Suite 599, Houston, TX 77063, United States of America
| | - Douglas W Woods
- Marquette University, 604 N. 16th St., Milwaukee, WI 53233, United States of America.
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15
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Self-concept and self-esteem in patients with chronic tic disorders: A systematic literature review. Eur J Paediatr Neurol 2018; 22:749-756. [PMID: 29859653 DOI: 10.1016/j.ejpn.2018.05.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 04/06/2018] [Accepted: 05/20/2018] [Indexed: 11/22/2022]
Abstract
Chronic tic disorders are neurodevelopmental conditions characterized by the presence of motor and/or phonic tics and often accompanied by co-morbid behavioral problems. Chronic tic disorders can negatively affect the level of functioning of young patients across social and family domains, with possible repercussions on their self-perception. We conducted a systematic literature review to assess the clinical correlates of both components of self-perception (self-concept, i.e. what patients think about themselves, and self-esteem, i.e. how they feel about their self-concept) in patients with chronic tic disorders. Reported levels of self-perception varied widely across studies, partly due to the methodological heterogeneity of the reviewed literature. Poor self-concept and self-esteem appeared to be more strongly related to the presence of psychiatric co-morbidities (especially obsessive-compulsive disorder, attention-deficit and hyperactivity disorder, and anxiety disorders) than to tic severity. Poor peer relationship, social difficulties, as well as problems with parents' acceptance were identified as further risk factors for low self-perception. Finally, the reviewed studies highlighted a link between self-perception and quality of life in patients with chronic tic disorders, alongside the protective role of good social adjustment. This information can therefore assist treating clinicians in the choice of tailored therapeutic interventions for this patient population, including behavioral management techniques that can improve self-concept and self-esteem through increased self-efficacy.
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16
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Schnell JML, Weidinger E, Musil R. [Patients with tics]. MMW Fortschr Med 2018; 160:47-50. [PMID: 30206848 DOI: 10.1007/s15006-018-0886-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Jaana M L Schnell
- Klinik für Psychiatrie und Psychotherapie des Klinikums der Universität München, Nussbaumstr. 7, D-80336, München, Deutschland.
| | - Elif Weidinger
- Klinik für Psychiatrie und Psychotherapie des Klinikums der Universität München, Nussbaumstr. 7, D-80336, München, Deutschland
| | - Richard Musil
- Klinik für Psychiatrie und Psychotherapie des Klinikums der Universität München, Nussbaumstr. 7, D-80336, München, Deutschland
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17
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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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18
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Meier SM, Dalsgaard S, Mortensen PB, Leckman JF, Plessen KJ. Mortality risk in a nationwide cohort of individuals with tic disorders and with tourette syndrome. Mov Disord 2017; 32:605-609. [DOI: 10.1002/mds.26939] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Revised: 12/05/2016] [Accepted: 12/19/2016] [Indexed: 11/09/2022] Open
Affiliation(s)
- Sandra M. Meier
- National Centre for Register-Based Research; NCRR, Aarhus University; Aarhus V Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH; Denmark
- Child and Adolescent Mental Health Centre - Mental Health Services Capital Region; Copenhagen Region Denmark
| | - Søren Dalsgaard
- National Centre for Register-Based Research; NCRR, Aarhus University; Aarhus V Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH; Denmark
| | - Preben B. Mortensen
- National Centre for Register-Based Research; NCRR, Aarhus University; Aarhus V Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH; Denmark
- CIRRAU - Centre for Integrated Register-based Research; Aarhus University; Aarhus V Denmark
| | - James F. Leckman
- Yale Child Study Center; Yale University; New Haven Connecticut USA
| | - Kerstin J. Plessen
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH; Denmark
- Child and Adolescent Mental Health Centre - Mental Health Services Capital Region; Copenhagen Region Denmark
- Department of Clinical Medicine; Faculty of Health Sciences, University of Copenhagen; Copenhagen Denmark
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Abstract
Gilles de la Tourette syndrome (GTS) is a childhood-onset neurodevelopmental disorder that is characterized by several motor and phonic tics. Tics usually develop before 10 years of age, exhibit a waxing and waning course and typically improve with increasing age. A prevalence of approximately 1% is estimated in children and adolescents. The condition can result in considerable social stigma and poor quality of life, especially when tics are severe (for example, with coprolalia (swearing tics) and self-injurious behaviours) or when GTS is accompanied by attention-deficit/hyperactivity disorder, obsessive-compulsive disorder or another neuropsychiatric disorder. The aetiology is complex and multifactorial. GTS is considered to be polygenic, involving multiple common risk variants combined with rare, inherited or de novo mutations. These as well as non-genetic factors (such as perinatal events and immunological factors) are likely to contribute to the heterogeneity of the clinical phenotype, the structural and functional brain anomalies and the neural circuitry involvement. Management usually includes psychoeducation and reassurance, behavioural methods, pharmacotherapy and, rarely, functional neurosurgery. Future research that integrates clinical and neurobiological data, including neuroimaging and genetics, is expected to reveal the pathogenesis of GTS at the neural circuit level, which may lead to targeted interventions.
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20
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Eapen V, Cavanna AE, Robertson MM. Comorbidities, Social Impact, and Quality of Life in Tourette Syndrome. Front Psychiatry 2016; 7:97. [PMID: 27375503 PMCID: PMC4893483 DOI: 10.3389/fpsyt.2016.00097] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 05/23/2016] [Indexed: 12/15/2022] Open
Abstract
Tourette syndrome (TS) is more than having motor and vocal tics, and this review will examine the varied comorbidities as well as the social impact and quality of life (QoL) in individuals with TS. The relationship between any individual and his/her environment is complex, and this is further exaggerated in the case of a person with TS. For example, tics may play a significant role in shaping the person's experiences, perceptions, and interactions with the environment. Furthermore, associated clinical features, comorbidities, and coexisting psychopathologies may compound or alter this relationship. In this regard, the common comorbidities include attention-deficit hyperactivity disorder and disruptive behaviors, obsessive compulsive disorder, and autism spectrum disorder, and coexistent problems include anxiety, depression, and low self-esteem, which can all lead to poorer psychosocial functioning and QoL. Thus, the symptoms of TS and the associated comorbid conditions may interact to result in a vicious cycle or a downward spiraling of negative experiences and poor QoL. The stigma and social maladjustment in TS and the social exclusion, bullying, and discrimination are considered to be caused in large part by misperceptions of the disorder by teachers, peers, and the wider community. Improved community and professional awareness about TS and related comorbidities and other psychopathologies as well as the provision of multidisciplinary services to meet the complex needs of this clinical population are critical. Future research to inform the risk and resilience factors for successful long-term outcomes is also warranted.
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Affiliation(s)
- Valsamma Eapen
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
- Academic Unit of Child Psychiatry, Ingham Institute, Sydney South Western Local Health District, Sydney, NSW, Australia
| | - Andrea E. Cavanna
- Department of Neuropsychiatry, Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK
- Aston Brain Centre, School of Life and Health Sciences, Aston University, Birmingham, UK
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London (UCL), London, UK
| | - Mary M. Robertson
- Neuropsychiatry, University College London (UCL), London, UK
- St Georges Hospital and Medical School, London, UK
- Department of Psychiatry, University of Cape Town, Cape Town, South Africa
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