Original article
Psychopathology in children and adolescents with Tourette's syndrome: A controlled study

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Abstract

Objective: Few controlled studies have considered, in paediatric subjects, associations between Tourette's syndrome (TS) and psychiatric/behavioural disorders. We conducted a case–control study to verify the reproducibility of the few data published on this topic to date. Method: Clinicians' impression (i.e. structured interviews and usual history taking), standardized psychiatric and behavioural rating scales (CBCL, TAI, CDI, CRS-R:L, Y-GTSS, CY-BOCS) were used to investigate these associations in 17 youngsters with TS and in 17 age- and sex-matched controls. Results: The clinician's diagnoses revealed TS alone in 23.5% of the patients (4/17), TS plus attention-deficit/hyperactivity disorder (ADHD) in 11.8% (2/17), TS plus obsessive–compulsive disorder (OCD) in 41.2% (7/17), and TS plus ADHD and OCD in 23.5% (4/17). No control subject presented ADHD and/or OCD. These clinical findings were confirmed by Child Behaviour Check List (CBCL) results. The TS group, compared with the controls, recorded significantly higher CBCL scores in scales relating to the main comorbid conditions. No significant differences emerged on the Children's Depression Inventory or Test Anxiety Inventory. Conclusion: TS patients have a high prevalence of psychiatric and behavioural problems compared with controls. The CBCL is a rapid and useful screening-diagnostic instrument for highlighting the main psychiatric and behavioural problems in TS.

Introduction

Tourette's syndrome (TS) is a neuropsychiatric disorder characterized by the presence of multiple motor tics plus one or more vocal (phonic) tics [1]. Opinions differ regarding its aetiology: many authors argue for an organic substrate involving neural basal ganglia circuits, while others draw attention to genetic influences, perinatal pathogenic noxae, infectious and autoimmune factors [2]. Others still have hypothesized a role for psychological factors in the onset and maintenance of the tic symptomatology [3].

TS is often associated with a broad spectrum of psychopathological and behavioural disorders, which are frequently the main reason for seeking medical help [4], [5]. Numerous studies have reported the presence of obsessive–compulsive symptoms [5], [6], [7], and of attention-deficit hyperactivity disorder (ADHD) [7], [8], [9], [10], in a large percentage of subjects affected by TS. In addition to these psychopathological manifestations, self-harm behaviour [11], anxious traits [12], [13], depression [4], personality disorders [14], aggressive and antisocial behaviours, conduct disorder and learning difficulties [5], [15] have also emerged as important features.

However, the literature contains few controlled studies that, using standardized scales for the assessment of behavioural and psychopathological aspects, have investigated TS specifically in children and adolescents [4], [16], [17], [18].

We conducted a case–control study in which standardized tests were used to assess psychopathological and behavioural features associated with TS in young subjects and to verify the reproducibility of the few data published on this topic to date.

Section snippets

Material and methods

The study sample was made up of 17 patients (14 males and three females), aged 7.3–17.4 years (mean age 11.4, SD=3.02 years), with TS diagnosed according to DSM-IV criteria [1], and consecutively referred for a first outpatient or inpatient consultation to the Department of Child Neurology and Psychiatry at the C. Mondino Institute of Neurology between January 2000 and December 2002. In-depth, anamnestic interviews were conducted with all the parents of the recruited patients, who had first

Results

Seventeen TS subjects (14 males and three females), aged between 7.3 and 17.4 years (mean age: 11.4, SD=3.02 years) were recruited, together with 17 age- and sex-matched controls (Table 1). The TS subjects recorded a mean Y-GTSS score of 56, SD=14.24 (range 28–81).

We excluded acquired Tourettism by means of laboratory-instrumental tests: cupraemia (17/17), ceruloplasmin (17/17), cupriuria (17/17), acanthocytes (17/17), ANA test (5/17), MRI (10/17) or brain CT scan (2/17), and EEG (14/17) were

Discussion

The results of this study, relating to a sample of children and adolescents with TS recruited at a single institute, show a significantly higher prevalence of psychopathological and behavioural disorders compared with a healthy sex- and age-matched control group. This is in accordance with findings reported in the few controlled studies on young TS patients published to date [4], [16], [17], [18]. The fact that similar results have also been obtained in a non-clinical population [5] provides

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