Differentiating tic-related from non-tic-related impairment in children with persistent tic disorders

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.

A Comprehensive Review of Tic Disorders in Children

“…Even when tic symptoms do not impair social, behavioral, or emotional functioning, comorbidities can negatively affect patients’ quality of life more than tics do [ 153 , 165 , 166 ]. Similarly, parents of children with tics reported that non-tic-related symptoms are more problematic than tics themselves [ 167 ]. A large clinical follow-up study of children and adolescents with TS showed an age-related decline in tics, ADHD, and OCD during adolescence, although other symptoms, such as sleep disturbance, remained [ 40 ].…”

Recent progress on Tourette syndrome

“…Although a large interview study across nine academic TS and OCD specialty clinics showed a correlation between tic severity and tic impairment 93 , non-tic-related symptoms can be more problematic than tics themselves 94 . Paying attention to comorbid symptoms and treatment is often more important than addressing tics themselves.…”

The Child with Tics or Other Common Movement Disorders

“…Even when tic symptoms do not impair social, behavioral, or emotional functioning, the comorbidities can negatively affect patients' quality of life more than tics do (Bernard et al 2009;Carter et al 2000;Eddy et al 2011b). Similarly, parents of children with tics reported that non-tic-related symptoms are more problematic than tics themselves (Stiede et al 2018). A large clinical follow-up study of children and adolescents with TS showed an age-related decline in tics, ADHD, and OCD during adolescence, although other symptoms, such as sleep disturbance, remained (Groth et al 2017).…”