Adulthood outcome of tic and obsessive-compulsive symptom severity in children with Tourette syndrome

Abstract

Background: Tourette syndrome (TS) is a childhood-onset neuropsychiatric disorder that is characterized by both motor and phonic tics. One half to two thirds of children with TS experience a reduction or complete resolution of tic symptoms during adolescence. At least one third of adults with TS have comorbid obsessive-compulsive disorder (OCD).

Objectives: To clarify the clinical course of tic and OCD symptoms in children with TS and determine if baseline clinical measurements in childhood are associated with future symptom severity in late adolescence and early adulthood.

Design: Prospective cohort study.

Setting: Yale Child Study Center tic and OCD outpatient specialty clinic.

Participants: Forty-six children with TS who received a structured clinical evaluation prior to age 14 years.

Main outcome measures: Expert-rated tic and OCD symptom severity at follow-up interview an average of 7.6 years later (range, 3.8-12.8 years).

Results: Eighty-five percent of subjects reported a reduction in tic symptoms during adolescence. Only increased tic severity in childhood was associated with increased tic severity at follow-up. The average age at worst-ever tic severity was 10.6 years. Forty-one percent of patients with TS reported at one time experiencing at least moderate OCD symptoms. Worst-ever OCD symptoms occurred approximately 2 years later than worst-ever tic symptoms. Increased childhood IQ was strongly associated with increased OCD severity at follow-up.

Conclusion: Obsessive-compulsive disorder symptoms in children with TS became more severe at a later age and were more likely to persist than tic symptoms.

Figure 1

Box plots comparing tic and obsessive-compulsive disorder (OCD) symptom severity at the time of initial assessment in childhood (time 1) and follow-up in early adulthood (time 2). Tic symptom severity scores were measured by the Yale Global Tic Severity Scale and are reported for all 46 subjects with Tourette syndrome. The OCD symptom severity scores were measured using the Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS) and are reported for those 19 patients with Tourette syndrome with lifetime worst-ever OCD symptom severity scores that were at least in the moderate-severity range (CY-BOCS score, ≥10) as assessed at time 2.

Figure 2

Box plot representing age when tic and obsessive-compulsive disorder (OCD) symptoms were at their worst. Age is represented for all 46 subjects with Tourette syndrome in this study sample. Age at worst-ever OCD symptoms were reported at follow-up for just those 19 patients with Tourette syndrome with lifetime worst-ever OCD symptom severity scores that were at least in the moderate-severity range (Children's Yale-Brown Obsessive Compulsive Scale score, ≥10).