Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Jul 17.
doi: 10.1007/s00787-025-02807-5. Online ahead of print.

Early developmental milestones associated with tics and psychopathological comorbidity: An EMTICS study

Tamar Steinberg #  1   2 , Dana Feldman-Sadeh #  1   2 , Alan Apter  1   2 , Yael Bronstein  1   2 , Noa Elfer  1 , Miri Carmel  3 , Elena Michaelovsky  3 , Abraham Weizman  3 , Matan Nahon  4 , Danny Horesh  4 , Astrid Morer  5 , Blanca Garcia Delgar  5 , Anette Schrag  6 , Silvana Fennig  1   2 , Pieter J Hoekstra  7   8 , Andrea Dietrich  7   8 ; EMTICS collaborative group; Noa Benaroya-Milshtein  9   10
Collaborators, Affiliations

Early developmental milestones associated with tics and psychopathological comorbidity: An EMTICS study

Tamar Steinberg et al. Eur Child Adolesc Psychiatry. .

Abstract

Background: Chronic Tic disorders (CTD) including Tourette Syndrome (TS), are associated with psychopathological comorbidities. Attention deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD) and other comorbidities have been linked to delays in early developmental milestones. Few studies have investigated the relationship between early developmental milestones, tic severity, and related comorbidities.

Methods: 383 participants aged 3-16 years (76.8%, n = 294 boys) with CTD from the baseline assessment of the European Multicenter Tics in Children Study (EMTICS), were evaluated for: retrospective early developmental milestones (sitting, walking, first words, complete a sentence, bladder and bowel control), tic severity, tic-related functional impairment, obsessive-compulsive disorder (OCD), ADHD, oppositional defiant disorder (ODD) and suspected ASD. Data was collected using gold-standard self and clinician reporting instruments. Analyses included Pearson correlations and logistic regressions.

Results: Correlations between the acquisition of developmental milestones and tic severity or impairment were significant with small effect sizes (severity of motor tics and tic impairment were correlated with walking (r = .11), while vocal tics were correlated with first words (r = .12)). Logistic regression revealed that delayed acquisition of first words was significantly associated with ADHD, ODD and suspected ASD (Odds Ratio (ROR): 1-1.13, 1.04-1.22, 1.05-1.21, respectively), while delayed walking acquisition was associated with OCD (ROR: 1.01-1.27).

Discussion: This study highlights the association between early developmental milestones and later psychopathological comorbidities in CTD patients. These findings emphasize the need for further research to distinguish between children with only tics and those with tics and psychopathological comorbidities, to improve early detection of individuals at risk.

Keywords: Attention deficit hyperactivity disorder (ADHD); Developmental milestones; Obsessive compulsive disorder (OCD); Tic disorders; Tourette syndrome.

PubMed Disclaimer

Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests.

References

    1. (2013) Diagnostic and statistical manual of mental disorders: DSM-5TM, 5th ed. American Psychiatric Publishing, Inc., Arlington, VA, US
    1. Bloch MH, Leckman JF (2009) Clinical course of Tourette syndrome. J Psychosom Res 67:497–501. https://doi.org/10.1016/j.jpsychores.2009.09.002 - DOI - PubMed - PMC
    1. Hirschtritt ME, Lee PC, Pauls DL et al (2015) Lifetime Prevalence, Age of Risk, and Genetic Relationships of Comorbid Psychiatric Disorders in Tourette Syndrome. JAMA Psychiat 72:325–333. https://doi.org/10.1001/jamapsychiatry.2014.2650 - DOI
    1. Groth C, Mol Debes N, Rask CU et al (2017) Course of Tourette Syndrome and Comorbidities in a Large Prospective Clinical Study. J Am Acad Child Adolesc Psychiatry 56:304–312. https://doi.org/10.1016/j.jaac.2017.01.010 - DOI - PubMed
    1. Cravedi E, Deniau E, Giannitelli M et al (2017) Tourette syndrome and other neurodevelopmental disorders: a comprehensive review. Child Adolesc Psychiatry Ment Health 11:59. https://doi.org/10.1186/s13034-017-0196-x - DOI - PubMed - PMC

LinkOut - more resources