Abstract
Some studies have shown that children and adolescents with obsessive–compulsive disorder (OCD) and co-morbid tics differ from those without co-morbid tics in terms of several demographic and clinical characteristics. However, not all studies have confirmed these differences. This study examined children and adolescents with OCD and with possible or definite tic specifiers according to the DSM-5 in order to see whether they differ from patients without any tic symptoms regarding clinical presentation and outcome of cognitive behavioral therapy (CBT). The full sample included 269 patients (aged 7–17) with primary DSM-IV OCD who had participated in the Nordic Long-term Treatment Study (NordLOTS). Symptoms of tics were assessed using the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS-PL). One or more tic symptoms were found in 29.9% of participants. Those with OCD and co-morbid tic symptoms were more likely male, more likely to have onset of OCD at an earlier age, and differed in terms of OCD symptom presentation. More specifically, such participants also showed more symptoms of OCD-related impairment, externalization, autism spectrum disorder (ASD), social anxiety, and attention-deficit/hyperactivity disorder (ADHD). However, the two groups showed no difference in terms of OCD severity or outcome of CBT. Children and adolescents with OCD and co-morbid tic symptoms differ from those without tic symptoms in several aspects of clinical presentation, but not in their response to CBT. Our results underscore the effectiveness of CBT for tic-related OCD.
Clinical trials registration: Nordic Long-term Obsessive–Compulsive Disorder (OCD) Treatment Study; www.controlled-trials.com; ISRCTN66385119.
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References
Bloch MH, Landeros-Weisenberger A, Rosario MC et al (2008) Meta-analysis of the symptom structure of obsessive-compulsive disorder. Am J Psychiatry 165:1532–1542. doi:10.1176/appi.ajp.2008.08020320
Flament MF, Whitaker A, Rapoport JL et al (1988) Obsessive compulsive disorder in adolescence: an epidemiological study. J Am Acad Child Adolesc Psychiatry 27:764–771. doi:10.1097/00004583-198811000-00018
Thomsen PH (1993) Obsessive-compulsive disorder in children and adolescents. Self-reported obsessive-compulsive behaviour in pupils in Denmark. Acta Psychiatr Scand 88:212–217. doi:10.1111/j.1600-0447.1993.tb03441.x
Canals J, Hernández-Martínez C, Cosi S, Voltas N (2012) The epidemiology of obsessive-compulsive disorder in Spanish school children. J Anxiety Disord 26:746–752. doi:10.1016/j.janxdis.2012.06.003
Ruscio AM, Stein DJ, Chiu WT, Kessler RC (2010) The epidemiology of obsessive-compulsive disorder in the National Comorbidity Survey Replication. Mol Psychiatry 15:53–63. doi:10.1038/mp.2008.94
Ivarsson T, Melin K, Wallin L (2008) Categorical and dimensional aspects of co-morbidity in obsessive-compulsive disorder (OCD). Eur Child Adolesc Psychiatry 17:20–31. doi:10.1007/s00787-007-0626-z
Eichstedt JA, Arnold SL (2001) Childhood-onset obsessive-compulsive disorder: a tic-related subtype of OCD? Clin Psychol Rev 21:137–157
Hanna GL, Piacentini J, Cantwell DP et al (2002) Obsessive-compulsive disorder with and without tics in a clinical sample of children and adolescents. Depress Anxiety 16:59–63. doi:10.1002/da.10058
Leonard HL, Lenane MC, Swedo SE et al (1992) Tics and Tourette’s disorder: a 2- to 7-year follow-up of 54 obsessive-compulsive children. Am J Psychiatry 149:1244–1251. doi:10.1176/ajp.149.9.1244
Robertson MM, Eapen V, Cavanna AE (2009) The international prevalence, epidemiology, and clinical phenomenology of Tourette syndrome: a cross-cultural perspective. J Psychosom Res 67:475–483. doi:10.1016/j.jpsychores.2009.07.010
Khalifa N, von Knorring A-L (2005) Tourette syndrome and other tic disorders in a total population of children: clinical assessment and background. Acta Paediatr 94:1608–1614. doi:10.1080/08035250510043879
Khalifa N, von Knorring A-L (2006) Psychopathology in a Swedish population of school children with tic disorders. J Am Acad Child Adolesc Psychiatry 45:1346–1353. doi:10.1097/01.chi.0000251210.98749.83
American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders, 5th edn. American Psychiatric Publishing, Arlington
Leckman JF, Denys D, Simpson HB et al (2010) Obsessive-compulsive disorder: a review of the diagnostic criteria and possible subtypes and dimensional specifiers for DSM-V. Depress Anxiety 27:507–527. doi:10.1002/da.20669
Lewin AB, Chang S, McCracken J et al (2010) Comparison of clinical features among youth with tic disorders, obsessive-compulsive disorder (OCD), and both conditions. Psychiatry Res 178:317–322. doi:10.1016/j.psychres.2009.11.013
Conelea CA, Walther MR, Freeman JB et al (2015) Tic-related obsessive-compulsive disorder (OCD): phenomenology and treatment outcome in the pediatric OCD treatment study II. J Am Acad Child Adolesc Psychiatry 53:1308–1316. doi:10.1016/j.jaac.2014.09.014
Tükel R, Polat A, Özdemir Ö et al (2002) Comorbid conditions in obsessive-compulsive disorder. Compr Psychiatry 43:204–209. doi:10.1053/comp.2002.32355
Valderhaug R, Ivarsson T (2005) Functional impairment in clinical samples of Norwegian and Swedish children and adolescents with obsessive-compulsive disorder. Eur Child Adolesc Psychiatry 14:164–173. doi:10.1007/s00787-005-0456-9
Storch EA, Larson MJ, Muroff J et al (2010) Predictors of functional impairment in pediatric obsessive-compulsive disorder. J Anxiety Disord 24:275–283. doi:10.1016/j.janxdis.2009.12.004
Piacentini J, Bergman RL, Keller M, McCracken J (2003) Functional impairment in children and adolescents with obsessive-compulsive disorder. J Child Adolesc Psychopharmacol 13:61–69. doi:10.1089/104454603322126359
Skarphedinsson G, Melin KH, Valderhaug R et al (2015) Evaluation of the factor structure of the child obsessive-compulsive impact scale—revised (COIS-R) in Scandinavia with confirmatory factor analysis. J Obsessive Compuls Relat Disord 7:65–72. doi:10.1016/j.jocrd.2015.03.005
Lack CW, Storch EA, Keeley ML et al (2009) Quality of life in children and adolescents with obsessive-compulsive disorder: base rates, parent-child agreement, and clinical correlates. Soc Psychiatry Psychiatr Epidemiol 44:935–942. doi:10.1007/s00127-009-0013-9
Holzer JC, Goodman WK, McDougle CJ et al (1994) Obsessive-compulsive disorder with and without a chronic tic disorder. A comparison of symptoms in 70 patients. Br J Psychiatry 164:469–473. doi:10.1192/bjp.164.4.469
Storch EA, Stigge-Kaufman D, Marien WE et al (2008) Obsessive-compulsive disorder in youth with and without a chronic tic disorder. Depress Anxiety 25:761–767. doi:10.1002/da.20304
Zohar AH, Pauls DL, Ratzoni G et al (1997) Obsessive-compulsive disorder with and without tics in an epidemiological sample of adolescents. Am J Psychiatry 154:274–276. doi:10.1176/ajp.154.2.274
Neal M, Cavanna AE (2013) Not just right experiences in patients with Tourette syndrome: complex motor tics or compulsions? Psychiatry Res 210:559–563. doi:10.1016/j.psychres.2013.06.033
Prado HS, Rosário MC, Lee J et al (2008) Sensory phenomena in obsessive-compulsive disorder and tic disorders: a review of the literature. CNS Spectr 13:425–432
Leckman JF, Grice DE, Barr LC et al (1994) Tic-related vs. non-tic-related obsessive compulsive disorder. Anxiety 1:208–215. doi:10.1002/anxi.3070010504
Banaschewski T, Neale BM, Rothenberger A, Roessner V (2007) Comorbidity of tic disorders and ADHD: conceptual and methodological considerations. Eur Child Adolesc Psychiatry. doi:10.1007/s00787-007-1002-8
Abramovitch A, Dar R, Mittelman A, Wilhelm S (2015) Comorbidity between attention deficit/hyperactivity disorder and obsessive-compulsive disorder across the lifespan: a systematic and critical review. Harv Rev Psychiatry 23:245–262. doi:10.1097/HRP.0000000000000050
Ivarsson T, Melin K (2008) Autism spectrum traits in children and adolescents with obsessive-compulsive disorder (OCD). J Anxiety Disord 22:969–978. doi:10.1016/j.janxdis.2007.10.003
Arildskov TW, Højgaard DRMA, Skarphedinsson G et al (2015) Subclinical autism spectrum symptoms in pediatric obsessive–compulsive disorder. Eur Child Adolesc Psychiatry. doi:10.1007/s00787-015-0782-5
Torp NC, Dahl K, Skarphedinsson G et al (2015) Effectiveness of cognitive behavior treatment for pediatric obsessive-compulsive disorder: acute outcomes from the Nordic Long-term OCD Treatment Study (NordLOTS). Behav Res Ther 64:15–23. doi:10.1016/j.brat.2014.11.005
Skarphedinsson G, Hanssen-Bauer K, Kornør H et al (2015) Standard individual cognitive behaviour therapy for paediatric obsessive-compulsive disorder: a systematic review of effect estimates across comparisons. Nord J Psychiatry 69:81–92. doi:10.3109/08039488.2014.941395
Rosa-Alcázar AI, Sánchez-Meca J, Rosa-Alcázar Á et al (2015) Psychological treatment of obsessive-compulsive disorder in children and adolescents: a meta-analysis. Span J Psychol 18:E20. doi:10.1017/sjp.2015.22
Weidle B, Jozefiak T, Ivarsson T, Thomsen PH (2014) Quality of life in children with OCD with and without comorbidity. Health Qual Life Outcomes 12:152. doi:10.1186/s12955-014-0152-x
Mansueto CS, Keuler DJ (2005) Tic or compulsion?: it’s Tourettic OCD. Behav Modif 29:784–799. doi:10.1177/0145445505279261
March JS, Franklin ME, Leonard H et al (2007) Tics moderate treatment outcome with sertraline but not cognitive-behavior therapy in pediatric obsessive-compulsive disorder. Biol Psychiatry 61:344–347. doi:10.1016/j.biopsych.2006.09.035
Garcia AM, Sapyta JJ, Moore PS et al (2010) Predictors and moderators of treatment outcome in the pediatric obsessive compulsive treatment study (POTS I). J Am Acad Child Adolesc Psychiatry 49:1024–1033. doi:10.1016/j.jaac.2010.06.013
Storch EA, Merlo LJ, Larson MJ et al (2008) Impact of comorbidity on cognitive-behavioral therapy response in pediatric obsessive-compulsive disorder. J Am Acad Child Adolesc Psychiatry 47:583–592. doi:10.1097/CHI.0b013e31816774b1
Torp NC, Dahl K, Skarphedinsson G et al (2015) Predictors Associated With Improved Cognitive-Behavioral Therapy Outcome in Pediatric Obsessive-Compulsive Disorder. J Am Acad Child Adolesc Psychiatry 54(200–207):e1. doi:10.1016/j.jaac.2014.12.007
Himle JA, Fischer DJ, Van Etten ML et al (2003) Group behavioral therapy for adolescents with tic-related and non-tic-related obsessive-compulsive disorder. Depress Anxiety 17:73–77. doi:10.1002/da.10088
Bennett S, Stark D, Shafran R et al (2015) Evaluation of cognitive behaviour therapy for paediatric obsessive-compulsive disorder in the context of tic disorders. J Behav Ther Exp Psychiatry 49:223–229. doi:10.1016/j.jbtep.2015.03.004
Ginsburg GS, Kingery JN, Drake KL, Grados MA (2008) Predictors of treatment response in pediatric obsessive-compulsive disorder. J Am Acad Child Adolesc Psychiatry 47:868–878. doi:10.1097/CHI.0b013e3181799ebd
McDougle CJ, Goodman WK, Leckman JF et al (1993) The efficacy of fluvoxamine in obsessive-compulsive disorder: effects of comorbid chronic tic disorder. J Clin Psychopharmacol 13:354–358
Geller Da, Biederman J, Stewart SE et al (2003) Impact of comorbidity on treatment response to paroxetine in pediatric obsessive-compulsive disorder: is the use of exclusion criteria empirically supported in randomized clinical trials? J Child Adolesc Psychopharmacol 13(Suppl 1):S19–S29. doi:10.1089/104454603322126313
Husted DS, Shapira NA, Murphy TK et al (2007) Effect of comorbid tics on a clinically meaningful response to 8-week open-label trial of fluoxetine in obsessive compulsive disorder. J Psychiatr Res 41:332–337. doi:10.1016/j.jpsychires.2006.05.007
March JS, Biederman J, Wolkow R (1998) Setraline in children and adolescents with obsessive compulsive disorder: a multicenter randomized controlled trial. JAMA 280:1752–1756
Skarphedinsson G, Compton S, Thomsen PH et al (2015) Tics moderate sertraline, but not cognitive-behavior therapy response in pediatric obsessive-compulsive disorder patients who do not respond to cognitive-behavior therapy. J Child Adolesc Psychopharmacol 25:432–439. doi:10.1089/cap.2014.0167
Thomsen PH, Torp NC, Dahl K et al (2013) The Nordic long-term OCD treatment study (NordLOTS): rationale, design, and methods. Child Adolesc Psychiatry Ment Health 7:41. doi:10.1186/1753-2000-7-41
Scahill L, Riddle MA, McSwiggin-Hardin M et al (1997) Children’s Yale-Brown obsessive compulsive scale: reliability and validity. J Am Acad Child Adolesc Psychiatry 36:844–852. doi:10.1097/00004583-199706000-00023
Storch EA, Murphy TK, Geffken GR et al (2004) Psychometric evaluation of the Children’s Yale-Brown obsessive-compulsive scale. Psychiatry Res 129:91–98. doi:10.1016/j.psychres.2004.06.009
Kaufman J, Birmaher B, Brent D et al (1997) Schedule for affective disorders and schizophrenia for school-age children-present and lifetime version (K-SADS-PL): initial reliability and validity data. J Am Acad Child Adolesc Psychiatry 36:980–988. doi:10.1097/00004583-199707000-00021
Lauth B, Arnkelsson GB, Magnússon P et al (2010) Validity of K-SADS-PL (schedule for affective disorders and schizophrenia for school-age children-present and lifetime version) depression diagnoses in an adolescent clinical population. Nord J Psychiatry 64:409–420. doi:10.3109/08039481003777484
Piacentini J, Peris TS, Bergman RL et al (2007) BRIEF REPORT: functional impairment in childhood OCD: development and psychometrics properties of the child obsessive-compulsive impact scale-revised (COIS-R). J Clin Child Adolesc Psychol 36:645–653. doi:10.1080/15374410701662790
Achenbach TM, Thomas M (1999) The child behavior checklist and related instruments. In: Mark E. Maruish (ed) use Psychol. Test. Treat. Plan. outcomes Assess., 2 nd edn. Lawrence Erlbaum Associates, Inc, Mahwah, pp 429–466
Angold A, Costello EJ, Messer SC et al (1995) Development of a short questionnaire for use in epidemiological studies of depression in children and adolescents. Int J Methods Psychiatr Res 5:237–249
Messer SC, Angold A, Costello JE, Loeber R, Van Kammen W, Stouthamer-Loeber M (1995) Development of a short questionnaire for use in epidemiological studies of depression in children and adolescents: factor composition and structure across development. Int J Methods Psychiatr Res 5:251–262
Wood A, Kroll L, Moore A, Harrington R (1995) Properties of the mood and feelings questionnaire in adolescent psychiatric outpatients: a research note. J Child Psychol Psychiatry 36:327–334. doi:10.1111/j.1469-7610.1995.tb01828.x
Ehlers S, Gillberg C (1993) The epidemiology of Asperger syndrome. J Child Psychol Psychiatry 34:1327–1350. doi:10.1111/j.1469-7610.1993.tb02094.x
Posserud MB, Lundervold AJ, Gillberg C (2006) Autistic features in a total population of 7–9-year-old children assessed by the ASSQ (autism spectrum screening questionnaire). J Child Psychol Psychiatry Allied Discip 47:167–175. doi:10.1111/j.1469-7610.2005.01462.x
Ehlers S, Gillberg C, Wing L (1999) A screening questionnaire for Asperger syndrome and other high-functioning autism spectrum disorders in school age children. J Autism Dev Disord 29:129–141
Gueorguieva R, Krystal JH (2004) Move over ANOVA: progress in analyzing repeated-measures data and its reflection in papers published in the archives of general psychiatry. Arch Gen Psychiatry 61:310–317. doi:10.1001/archpsyc.61.3.310
Samuels J, Grados MA, Riddle MA et al (2014) Hoarding in children and adolescents with obsessive–compulsive disorder. J Obsessive Compuls Relat Disord 3:325–331. doi:10.1016/j.jocrd.2014.08.001
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The authors would like to thank TrygFonden, Lundbeck Foundation and Central Region Denmark’s Research Fund for supporting the research presented in this article through project Grants.
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Tord Ivarsson: Speaker’s bureau for Shire Sweden. On behalf of all other authors, the corresponding author states that there is no conflict of interest.
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Højgaard, D.R.M.A., Skarphedinsson, G., Nissen, J.B. et al. Pediatric obsessive–compulsive disorder with tic symptoms: clinical presentation and treatment outcome. Eur Child Adolesc Psychiatry 26, 681–689 (2017). https://doi.org/10.1007/s00787-016-0936-0
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DOI: https://doi.org/10.1007/s00787-016-0936-0