A cluster analysis of tic symptoms in children and adults with Tourette syndrome: clinical correlates and treatment outcome

Abstract

Cluster analytic methods have examined the symptom presentation of chronic tic disorders (CTDs), with limited agreement across studies. The present study investigated patterns, clinical correlates, and treatment outcome of tic symptoms. 239 youth and adults with CTDs completed a battery of assessments at baseline to determine diagnoses, tic severity, and clinical characteristics. Participants were randomly assigned to receive either a comprehensive behavioral intervention for tics (CBIT) or psychoeducation and supportive therapy (PST). A cluster analysis was conducted on the baseline Yale Global Tic Severity Scale (YGTSS) symptom checklist to identify the constellations of tic symptoms. Four tic clusters were identified: Impulse Control and Complex Phonic Tics; Complex Motor Tics; Simple Head Motor/Vocal Tics; and Primarily Simple Motor Tics. Frequencies of tic symptoms showed few differences across youth and adults. Tic clusters had small associations with clinical characteristics and showed no associations to the presence of coexisting psychiatric conditions. Cluster membership scores did not predict treatment response to CBIT or tic severity reductions. Tic symptoms distinctly cluster with little difference across youth and adults, or coexisting conditions. This study, which is the first to examine tic clusters and response to treatment, suggested that tic symptom profiles respond equally well to CBIT. Clinical trials.gov. identifiers: NCT00218777; NCT00231985.

Keywords: Chronic tic disorders; Cluster analysis; Comprehensive behavioral intervention for tics; Habit reversal training; Tic symptom profiles; Treatment outcome.

Figure 1

Hierarchical agglomerative cluster analysis on YGTSS Symptom Checklist Cluster 1 = Complex Phonic Tic&Impulse Control Tics; Cluster 2 = Complex Motor Tics; Cluster 3 = Simple Head Region Motor/Vocal Tics; Cluster 4 = Primarily Simple Motor Tics