Understanding disability in Tourette syndrome

The aim of this study was to understand how children with Tourette syndrome (TS), with or without attention-deficit-hyperactivity disorder (ADHD) and/or obsessive-compulsive disorder (OCD), experience disability. Children seen at two TS centres were eligible for participation. Clinicians compiled baseline information and symptom severity rating scales. Parents completed the Child Health Questionnaire, a measure of physical and psychosocial health. Seventy-one children (56 males, 15 females); mean age 11y 2mo [SD 3y 1mo], range 7-17y) were analyzed in the subgroups: TS only (n=20), TS+ADHD (n=22), TS+ADHD+OCD (n=18), and TS+OCD (n=11). Almost all psychosocial domain scores were significantly lower than national norms for the TS+ADHD and TS+ADHD+OCD subgroups (p < 0.001). For the TS only subgroup, only the family activities domain was significantly affected. Psychosocial summary scores were 53.2 for norms, 54.4 for the TS only subgroup (ns), 41.4 for the TS+ADHD subgroup (p < 0.001), 35.3 for the TS+ADHD+OCD subgroup (p < 0.001), and 35.5 for the TS+OCD group (p=0.003). A multiple linear regression model including diagnosis, age, sex, and TS, OCD, and ADHD symptom severity found that the most significant predictor of the psychosocial summary score was ADHD symptom severity (R(2)=0.55, p < 0.001). Children with TS+ADHD +/- OCD experience impairment in all aspects of psychosocial health. For children with TS only, psychosocial health was not different from that of the normative population in the majority of domains tested. This suggests treatment of ADHD and OCD should be the priority in children with multiple diagnoses.