Psychometric Properties of a Self-Report Instrument for the Assessment of Tic Severity in Adults With Tic Disorders

doi:10.1016/j.beth.2015.06.002

Behavior Therapy

Volume 46, Issue 6, November 2015, Pages 786-796

https://doi.org/10.1016/j.beth.2015.06.002 Get rights and content

Highlights

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We describe the development of the ATQ, a multidimensional measure of tic severity in adults
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The ATQ is a brief self-report measure that provides both global and detailed tic-specific scores
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The ATQ demonstrates strong psychometric properties
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The ATQ may be particularly useful for assessing treatment progress in research and clinical settings

Abstract

The gold-standard measure of tic severity in tic disorders (TD), the Yale Global Tic Severity Scale (YGTSS), is a semistructured clinician-administered interview that can be time consuming and requires highly trained interviewers. Moreover, the YGTSS does not provide information regarding frequency and intensity of specific tics because all motor and all vocal tics are rated as a group. The aim of the present study is to describe and test the Adult Tic Questionnaire (ATQ), a measure for the assessment of tic severity in adults, and to report its preliminary psychometric properties. The ATQ is a brief self-report questionnaire that provides information regarding frequency, intensity, and severity of 27 specific tics. In addition, the ATQ produces total frequency, intensity, and severity scores for vocal and motor tics, as well as a global total tic severity score. Results showed that the ATQ demonstrated very good internal consistency and temporal stability. The total, vocal, and motor tic severity scales of the ATQ showed strong correlation with corresponding subscales of the YGTSS, indicating strong convergent validity. Weak correlations with measures of severity of obsessive-compulsive disorder and attention deficit/hyperactivity disorder, indicated strong discriminant validity. The ATQ, a promising measure for the assessment of tic severity in adults with TD, may be a valuable supplement to the current recommended assessment battery for TD. Furthermore, the ATQ enables clinicians and researchers to track changes in the frequency and intensity of specific tics, which is important given their complex and dynamic nature.

Section snippets

Development and Scoring of the Adult Tic Questionnaire (ATQ)

The ATQ (see Appendix) was directly modeled after the Parent Tic Questionnaire (PTQ; Chang et al., 2009), a self-report inventory administered to parents for the assessment of tic severity in youth. The PTQ demonstrates strong psychometric properties, including construct validity, internal consistency, and test-retest reliability (Chang et al., 2009). Similar to the PTQ, the ATQ includes a list of 14 common motor tics and 13¹

Results

Demographic and clinical indices are presented in Table 1. The sample had an average IQ score (106). The mean YGTSS total score indicated a moderate to severe degree of tic severity (according to severity ranges offered by Bloch et al., 2006). Overall severity of OCD symptoms was in the nonclinical range. More than half the sample (54%) was not diagnosed with any comorbid condition. Of those with a co-occurring condition, the most prevalent comorbid conditions were ADHD (28%) and OCD (16%).

Discussion

The aim of the present study was to present initial psychometric data on the ATQ, a brief self-report measure for the assessment of tic severity in adults with TD. The ATQ demonstrated very good internal consistency and temporal stability between the screening and baseline assessment. The ATQ subscale scores correlated strongly with the YGTSS, demonstrating strong convergent construct validity. Correlations between the ATQ and Y-BOCS and ADHD-RS subscales were weaker compared to the

Conclusion

The ATQ is a promising addition to the current assessment battery of TD. It demonstrates very good psychometric properties, provides valuable multidimensional tic-specific information, and a highly needed option to assess tics online. Furthermore, previous preliminary examination of the ATQ in a randomized clinical trial demonstrated its sensitivity to change with BT for tic disorders, but more research is needed in order to examine the utility and sensitivity of the ATQ in clinical trials.

Conflict of Interest Statement

Drs Abramovitch and Reese declare no conflict of interest.

Drs Wilhelm, Peterson, Piacentini, Woods, and Scahill report receiving royalties from Oxford University Press for a treatment manual on tic disorders.

Drs Wilhelm, Peterson, Piacentini, Woods, and Scahill report receiving honoraria for continuing education presentations from the Tourette Syndrome Association. Drs Piacentini, and Woods, receive royalties from Guilford Press for a book on Tourette disorder.

Dr Wilhelm reports receiving

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However, this report extends this initial psychometric investigation by utilizing a larger treatment-seeking clinical sample, and investigating discriminant validity using a broad array of comorbid constructs (e.g., internalizing and externalizing symptoms). Findings were also consistent with the initial psychometric investigation of the adult version of this scale, the Adult Tic Questionnaire, which shows strong psychometric properties (Abramovitch et al., 2015). In addition, this report examined the efficiency of tic severity reduction cutoffs associated with positive treatment response.
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^☆: This work was supported by grants from the National Institute of Mental Health (NIMH) to Drs. Wilhelm (5R01MH069877), Scahill (R01MH069874), and Peterson (RO1MH069875) with subcontracts to Drs. Piacentini and Woods.

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Psychometric Properties of a Self-Report Instrument for the Assessment of Tic Severity in Adults With Tic Disorders☆