Premonitory Urge for Tics Scale (PUTS): replication and extension of psychometric properties in youth with chronic tic disorders (CTDs)

Abstract

Individuals with chronic tic disorders (CTDs) frequently describe aversive subjective sensory sensations that precede their tics. The first aim of the present study was to explore the psychometric properties of a standardized self-report measure to assess premonitory urges in CTDs, The Premonitory Urge for Tics Scale (PUTS), by replicating the analyses of Woods et al. (J Dev Behav Pediatr 26:397-403, 2005) using a sample twice the size of theirs. The second aim was to conduct an exploratory factor analysis of the PUTS. Eighty-four youth with CTDs, recruited from a pediatric OCD and tic specialty clinic, completed the PUTS while their caregivers completed The Parent Tic Questionnaire (PTQ) and a demographic measure. Consistent with (Woods et al. J Dev Behav Pediatr 26:397-403, 2005), the PUTS was found to be internally consistent (α = 0.82) and significantly correlated with overall tic severity as measured by the PTQ (r = 0.24, p < 0.05) as well as the PTQ number (r = 0.34, p < 0.01) and intensity (r = 0.24, p < 0.05) subscales. A factor-analysis of the PUTS revealed a two-factor solution with one factor capturing the quality of premonitory sensations while the other factor assessed the overall intensity of the urges. These results support the use of the PUTS in reliably measuring premonitory urges, particularly in children over the age of 10 years. Additionally, these findings highlight that urges are uniformly reported across gender and age and are more closely associated with number of tics than the frequency or intensity of tics.

The Premonitory Urge for Tics Scale in a large sample of children and adolescents: psychometric properties in a developmental context. An EMTICS study

“…The aim of the present study, therefore, was to examine the psychometric properties of the PUTS in a large sample of 656 children, aged 3-16 years (of which 356 children were below 11 years) from an European multicenter study. We aimed to replicate previous work [12,16,17] and to further investigate the psychometric properties in young children. First, we investigated the internal consistency of the PUTS.…”

“…The Premonitory Urge for Tics Scale (PUTS [12]) is the most frequently used self-report measure to assess the severity of premonitory urges. Studies investigating the psychometric properties of the PUTS have so far indicated a good internal reliability and correlations with the Yale Global Tic Severity Scale (YGTSS [15]) for children of 11 years and older, but not for younger children [12,16,17]. Similarly, PUTS scores of children aged 11 years and older (and not younger children) correlated well with the Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS [18]), which might not be surprising given that some premonitory urges (i.e.…”

“…'the feeling that something is not "just right" or not complete') have been shown to be related to OCD symptoms [5]. Thus, while studies so far observed good psychometric properties of the PUTS in children of 11 years and older [12,16,17], the suitability of the PUTS for younger children has not yet been established, even though premonitory urges may already be present at a young age.…”

“…We distinguished three age groups: children ≤ 7 years (n = 103), children between 8 and 10 years (n = 253), and children ≥ 11 years (n = 300). As a supplementary analysis to allow for comparisons with the existing literature [12,16,17], we also divided our sample into two age groups; children ≤ 10 years, (n = 356) and children and adolescents ≥ 11 years, (n = 300).…”

“…Furthermore, the underlying factor structure of the PUTS was investigated by conducting a principal axis exploratory factor analysis (EFA). We used direct oblimin rotation, as we assumed that possible factors would be correlated in line with a previous study [16], first, for the total group, and then for different age groups. The factorability of the data (i.e.…”