The Presence of Attention-Deficit Hyperactivity Disorder (ADHD) and Obsessive-Compulsive Disorder Worsen Psychosocial and Educational Problems in Tourette Syndrome

Abstract

We assessed the psychosocial and educational consequences of Tourette syndrome using a structured interview and child behavior checklist in 314 children with Tourette syndrome and 81 healthy controls. Of the children with Tourette syndrome, 59.0% needed some kind of educational support, 44.7% had been teased, and 61.8% withheld themselves from taking part in social activities because of Tourette syndrome-related problems. There were significantly more psychosocial and educational problems in children with Tourette syndrome compared with healthy controls. A higher rate of these problems was also seen if the comorbidities attention-deficit hyperactivity disorder (ADHD) and/or obsessive compulsive disorder were present. It is very important for the physicians, teachers, and other professionals to be aware of the high prevalence of these social and educational problems to be able to deal with them and to teach the families to cope with them.

Keywords

Tourette syndrome psychosocial consequences comorbidity ADHD

Get full access to this article

View all access options for this article.

References

DSM-IV-TR criteria from the American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association; 2000.

Robertson MM Attention deficit hyperactivity disorder, tics and Tourette’s syndrome: the relationship and treatment implications . Eur Child Adolesc Psychiatry. 2006;15(11):1-11.

Stokes A. , Bawden HN , Camfield PR , Backman JE , Dooley JM Peer problems in Tourette’s disorder. Pediatrics. 1991; 87(61):936-942.

Carter AS , O’Donnell DA , Schultz RT , et al. Social and emotional adjustment in children affected with Gilles de la Tourette’s syndrome: associations with ADHD and family functioning . J Child Psychol Psychiatry. 2000;41(2):215-223.

Champion LM , Fulton WA , Shady GA

Tourette syndrome and social functioning in a

Canadian population. Neurosci Biobehav Rev. 1988;12(3-4):255-257.

Bawden HN , Stokes A. , Camfield CS , Camfield PR , Salisbury S. Peer relationship problems in children with Tourette’s disorder or diabetes mellitus. J Child Psychol Psychiatry. 1998 ;39(5): 663-668.

Dedmon R. Tourette syndrome in children: knowledge and services. Health Soc Work. 1990;15(2):107-115.

Chowdhury U. , Heyman I. Tourette’s syndrome in children. BMJ. 2004;329(7479):1356-1357.

Zhu Y. , Leung KM , Liu PZ , Zhou M. , Su LY Comorbid behavioural problems in Tourette’s syndrome are positively correlated with the severity of tic symptoms. Aust N Z J Psychiatry . 2006;40(1):67-73.

10.

Elstner K. , Selai CE , Trimble MR , Robertson MM Quality of Life (QOL) of patients with Gilles de la Tourette’s syndrome . Acta Psychiatr Scand. 2001;103(1):52-59.

11.

Leckman JF , Bloch MH , Scahill L. , King RA Tourette syndrome: the self under siege. J Child Neurol. 2006;21(8):642-649.

12.

Leckman JF Tourette’s syndrome. Lancet. 2002;360(9345): 1577-1586.

13.

Packer L. Social and educational resources for patients with Tourette syndrome. Neurol Clin. 1997;15(2):457-473.

14.

Singer HS , Schuerholz LJ , Denckla MB Learning difficulties in children with Tourette syndrome. J Child Neurol. 1995; 10(suppl 1):S58-S61.

15.

Burd L. , Kauffman DW , Kerbeshian J. Tourette syndrome and learning disabilities. J Learn Disabil. 1992;25(9):598-604.

16.

Golden GS Psychologic and neuropsychologic aspects of Tourette’s syndrome. Neurol Clin. 1984;2(1):91-102.

17.

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth edition. Washington, DC: American Psychiatric Association; 1994.

18.

Rasmussen NH Diagnosis of ADHD, hyperkinetic disturbance, and DAMP in children. A review. Ugeskr Læger. 2002; 164(40):4631-4636.

19.

Goodman WK , Price LH , Rasmussen SA , et al. The Yale-Brown Obsessive Compulsive Scale. I. Development, use, and reliability. Arch Gen Psychiatry. 1989 ;46(11):1006-1011.

20.

Scahill L. , Riddle MA , McSwiggin-Hardin M. , et al. Children’s Yale-Brown Obsessive Compulsive Scale: reliability and validity. J Am Acad Child Adolesc Psychiatry. 1997;36(6):844-853.

21.

Storch EA , Murphey TK , Geffken GR , et al. Psychometric evaluation of the Children’s Yale-Brown Obsessive-Compulsive Scale. Psychiatry Res. 2004;129(1):91-98.

22.

Leckman JF , Riddle MA , Hardin MT , et al. The Yale Global Tic Severity Scale: initial testing of a clinician-rated scale of tic severity. J Am Acad Child Adolesc Psychiatry . 1989;28(4):566-573.

23.

Storch EA , Murphy TK , Geffken GR , et al. Reliability and validity of the Yale Global Tic Severity Scale . Psychol Assess. 2005;17(4):486-491.

24.

Bilenberg N. The Child Behavior Checklist (CBCL) and related material: standardization and validation in Danish population based and clinically based samples. Acta Psychiatr Scand Suppl. 1999;398:2-52.

25.

Wechsler D. WISC-IIIDK. Oversat af Henny Thomsen. Dansk Psykologisk Forlag, 2004.

26.

Danish Social Research Institute. www.sfi.dk. Accessed November 11, 2008.

27.

Debes NM , Hjalgrim H. , Skov L. Validation of the presence of comorbidities in a Danish clinical cohort of children with Tourette syndrome. J Child Neurol. 2008;23(9):1017-1027.

28.

Edell BH , Motta RW The emotional adjustment of children with Tourette’s syndrome. J Psychol. 1989;123(1):51-57.

29.

Lin H. , Katsovich L. , Ghebremichael M. , et al. Psychosocial stress predicts future symptom severities in children and adolescents with Tourette syndrome and/or obsessive-compulsive disorder . J Child Psychol Psychiatry. 2007;48(2):157-166.

30.

Undervisningsministeriet, http://www.uvm.dk/∼/media/Files/Stat/Folkeskolen/PDF07/071231_vidtgaaende_2006.ashx. Accessed November 12, 2008.

31.

Pappert EJ , Goetz CG , Louis ED , Blasucci L. , Leurgans S. Objective assessments of longitudinal outcome in Gilles de la Tourette’s syndrome. Neurology. 2003;61(7):936-940.

32.

Abwender DA , Como PG , Kurlan R. , Parry K. , Fett KA , Cui L. School problems in Tourette’s syndrome. Arch Neurol . 1996;53(6):509-511.

33.

Sukhodolsky DG , Scahill L. , Zhang H. , et al. Disruptive behavior in children with Tourette’s syndrome: association with ADHD comorbidity, tic severity, and functional impairment. J Am Acad Child Adolesc Psychiatry . 2003;42(1):98-105.

34.

Sukhodolsky DG , do Rosario-Campos MC , Scahill L. , et al. Adaptive, emotional, and family functioning of children with obsessive-compulsive disorder and comorbid attention deficit hyperactivity disorder. Am J Psychiatry. 2005;162(6):1125-1132.

35.

Erenberg G. , Cruse RP , Rothner AD The natural history of Tourette syndrome: a follow-up study. Ann Neurol. 1987; 22(3):383-385.

36.

Schuerholz LJ , Baumgardner TL , Singer HS , Reiss AL , Denckla MB Neuropsychological status of children with Tourette’s syndrome with and without attention deficit hyperactivity disorder. Neurology. 1996;46(4):958-965.

37.

Channon S. , Pratt P. , Robertson MM Executive function, memory, and learning in Tourette’s syndrome. Neuropsychology. 2003;17(2):247-254.

38.

Robertson MM Tourette syndrome, associated conditions and the complexities of treatment. Brain. 2000 ;123(pt 3):425-462.

39.

Ringman JM , Jankovic J. Occurrence of tics in Asperger’s syndrome and autistic disorder. J Child Neurol. 2000;15(6):394-400.

40.

Canitano R. , Vivanti G. Tics and Tourette syndrome in autism spectrum disorders. Autism. 2007;11(1):19-28.

41.

Kostanecka-Endress T. , Banaschewski T. , Kinkelbur J. , et al. Disturbed sleep in children with Tourette syndrome A polysomnographic study. J Psychosom Res. 2003;55(1):23-29.

42.

De Nil LF , Sasisekaran J. , Van Lieshout PH , Sandor P. Speech disfluencies in individuals with Tourette syndrome. J Psychosom Res. 2005;58(1):97-102.

43.

Børnerådets ‘‘Mobning 2008.’’ http://www.boerneraadet.dk/temaer/mobning/mobberapporter . Accessed November 12, 2008.