Published online Jul 19, 2022. doi: 10.5498/wjp.v12.i7.958
Peer-review started: December 21, 2021
First decision: March 13, 2022
Revised: April 6, 2022
Accepted: June 27, 2022
Article in press: June 27, 2022
Published online: July 19, 2022
Processing time: 210 Days and 2.7 Hours
Tourette syndrome (TS) is a complex neurodevelopmental condition marked by tics, as well as a variety of psychiatric comorbidities, such as obsessive-compulsive disorders (OCDs), attention deficit hyperactivity disorder (ADHD), anxiety, and self-injurious behavior. However, no Chinese version of the TRTS criteria has been described. Moreover, the different criteria for TRTS were established mostly based on the clinical characteristics of adult patients with Tourette syndrome.
We need more confirmatory evidence about the clinical characteristics of TRTS. However, few studies have focused on the behavioral and emotional components of TRTS. Identifying the “indicators” of TRTS in the early stage may help in the treatment of these patients. Whether TRTS is different from “pure TS” (only tic symptoms without comorbidities) is unknown. More evidence is needed to explore these differences, especially at the early stage of TRTS.
This study aimed to examine the clinical characteristics of TRTS in a Chinese pediatric population, compare the clinical characteristics (i.e., the onset of tic age, duration of illness, intelligence quotient (IQ), and behavioral and emotional problems) of patients with TRTS and non-TRTS patients, and report the locations and the frequency of tic onset in TRTS.
A total of 126 pediatric patients aged 6-12 years with TS were identified, including 64 TRTS and 62 non-TRTS patients. The Yale Global Tic Severity Scale (YGTSS), Premonitory Urge for Tics Scale (PUTS), and Child Behavior Checklist (CBCL) were used to assess these two groups and compared the difference between the TRTS and non-TRTS groups. Descriptive statistics were performed to identify the basic clinical information, and t tests or χ2 tests were used to compare the different variables of different TS groups.
When compared with the non-TRTS group, we found that the age of onset for TRTS was younger (P < 0.001), and the duration of illness was longer (P < 0.001). TRTS was more often caused by psychosocial (P < 0.001) than physiological factors, and coprolalia and inappropriate parenting style were more often present in the TRTS group (P < 0.001). The TRTS group showed a higher level of premonitory urge (P < 0.001), a lower intelligence quotient (IQ) (P < 0.001), and a higher percentage of family history of TS. The TRTS patients demonstrated more problems (P < 0.01) in the “Uncommunicative”, “Obsessive-Compulsive”, “Social-Withdrawal”, “Hyperactive”, “Aggressive”, and “Delinquent” subscales in the boys group, and “Social-Withdrawal” (P = 0.02) subscale in the girls group.
Pediatric TRTS might show an earlier age of onset age, longer duration of illness, lower IQ, higher premonitory urge, and higher comorbidities with ADHD-related symptoms and OCD-related symptoms than ‘pure TS’. Moreover, TRTS shows more social communication deficits that need to be covered in both the assessment and treatment of TRTS. TRTS might be one of the subtypes of TS. We need to develop a proper Chinese version definition of the TRTS in the future, especially for pediatric patients.
In previous studies, we focused more on ADHD and obsessive-compulsive symptoms in TRTS, and social communication-related problems seemed to be neglected. It should be noted that social communication deficits are crucial signs of functional impairment, suggesting that we also need to assess social communication deficits during the assessment of function in TRTS. Therefore, we should pay more attention to social communication deficits in TRTS regardless of the assessment or the treatment.