Disentangling the effects of Tourette syndrome and attention deficit hyperactivity disorder on cognitive and behavioral phenotypes

University of Rome Tor Vergata, Roma, Latium, Italy
Brain and Development (Impact Factor: 1.54). 09/2007; 29(7):413-20. DOI: 10.1016/j.braindev.2006.12.003
Source: PubMed

ABSTRACT Eighty participants (62 males; 18 females; age range: 6-16 years) took part in the study, comprising four groups of 20 subjects each: TS-only, ADHD-only, TS+ADHD, controls. The age distributions, did not differ significantly among the four groups. The severity of symptoms, assessed by the TSGS, did not differ significantly between the two TS groups. Standardised measures were used throughout. The "cases" (i.e. TS-only, TS+ADHD, ADHD-only) were significantly different from controls on most measures of behavior. There were also differences amongst the various clinical subgroups, with, in general, TS-only participants being similar to controls with regards to both "total behavior" ratings and cognitive testing results. A diagnosis of ADHD, either or its own or in association with TS, was associated with greater maladaptive behavior and worse cognitive functioning. With regards to affective symptoms and anxiety, the three clinical groups did not differ from each other, but each of them was more affected than the control group. One finding in our study which differed from previous literature was that TS-only patients were rated as more "delinquent" than controls by their parents: possible reasons for this are discussed. Oppositional defiant disorder (ODD) was seen in a few (2,3,3 ODD patients in each clinical group), but as numbers were small no statistics were undertaken. Family histories were in accord with both TS and ADHD being genetic disorders, but sharing an overlap in only some cases. The "additive effect" hypothesis is discussed in detail in the light of our results and recent literature.

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    • "Studies report a high prevalence of ADHD in TD populations ; a multisite epidemiological study estimated the co-occurrence to be about 55% in clinical populations (Freeman, 2007). Children with TD who have a cooccurring second disorder have been found to have poorer emotional, social, and academic function (Debes, Hjalgrim, & Skov, 2010; Rizzo et al., 2007). Clinicians therefore need to be aware of comorbidity. "
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    ABSTRACT: Attention-deficit hyperactivity disorder (ADHD) and Gilles de la Tourette syndrome (GTS) are commonly co-occurring neurodevelopmental conditions. This article explores the mechanism of co-occurrence by describing shared biogenetic, neural, and cognitive risk factors between the two disorders. Neuroanatomical risk factors underlie atypical neuropsychological profiles of motor control and inhibition. Features of inhibition (impulsivity in ADHD and tics in GTS) may be a disadvantage in ADHD but may present as a protective factor in GTS. The application of cognitive manifestations for assessment and behavioral management in GTS is considered.
    07/2012; 1(2):129-36. DOI:10.1080/21622965.2012.703889
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    • "JOURNAL OF CHILD AND ADOLESCENT PSYCHOPHARMACOLOGY Volume 19, Number 6, 2009 ª Mary Ann Liebert, Inc. Pp. 737–748 DOI: 10.1089=cap.2009.0013 (e.g., Comings and Comings 1987a,b; Pierre et al. 1999; Spencer et al. 1998; Gadow et al. 2002; Roessner et al. 2007), although there are negative findings (e.g., Sukhodolsky et al. 2003; Rizzo et al. 2007). This is likely explained, at least in part, by the extraordinary diversity of methods for characterizing clinical phenotypes and assessing symptoms and procedures for identifying and recruiting cases (replication drift) and the relatively small number of subjects in diagnostic subgroups, thus limiting the ability to detect group differences. "
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    ABSTRACT: This study examined the psychosocial and behavioral concomitants of anxiety in clinic-referred boys with attention-deficit/hyperactivity disorder (ADHD) with and without chronic multiple tic disorder (CMTD). ADHD boys with (n = 65) and without (n = 94) CMTD were evaluated with measures of psychiatric symptoms, mental health risk factors, and academic and social performance. Boys with CMTD evidenced more severe anxiety and less social competence and were more likely to be living with only one biological parent than the ADHD Only group, but the magnitude of group differences was generally small. The severity of generalized anxiety, separation anxiety, social phobia, and obsessive-compulsive symptoms were uniquely associated with a different pattern of risk factors, and there was some evidence that these patterns differed for the two groups of boys. Boys with CMTD had a relatively more severe and complex pattern of anxiety that was associated with different clinical features, all of which suggests that ADHD plus CMTD might better be conceptualized as a distinct clinical entity from ADHD Only. However, findings from the extant literature are mixed, and therefore this remains a topic for further study.
    Journal of child and adolescent psychopharmacology 12/2009; 19(6):737-48. DOI:10.1089/cap.2009.0013 · 3.07 Impact Factor
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    • "or they have just included ADHD and OCD [10] or ADHD and ODD [9]. Therefore, it is essential to study co-morbidities which include more disorders such as SAD, ODD, and CD. "
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    ABSTRACT: Objective: Many previous studies have surveyed associations between Tourette syndrome (TS) and co-morbid psychiatric disorders, but they usually did not include oppositional defiant disorder (ODD), conduct disorder (CD), separation anxiety disorder (SAD), and post-traumatic stress disorder (PTSD). Method: The subjects were children and adolescents with TS who visited a child and adolescent psychiatric clinic, and who were interviewed using DSM-IV diagnostic criteria. Characteristics of their tics were examined by the Yale-Global Tic Severity Scale (Y-GTSS). Behavioral problems were surveyed by the Child Behavior Checklist (CBCL) filled in by the parents. Results: About 87.9% of the subjects were boys. The mean age of the subjects was 11.8 years. The most common psychiatric disorders were attention deficit hyperactivity disorder (ADHD), ODD, nail biting, and obsessive compulsive disorder (OCD). Only one subject was affected by TS without co-morbidities. Among TS patients with co-morbidities, those with disruptive behavioral disorders (DBD) have significantly higher mean scores than patients without DBD on the Externalizing scale, Social problems, Attention problems, Delinquent and Aggression scales. Co-morbidity of anxiety disorders was not related to the CBCL scores. Conclusion: Many of our results were similar to those reported in studies conducted in other parts of the world. TS is more common in boys and nearly all of them had at least one co-morbid disorder. The most common co-morbidity was ADHD. Behavioral problems in TS are related to the co-morbidity with the DBD, and possibly not to the anxiety disorders.
    Brain & development 01/2009; 31(1-31):15-19. DOI:10.1016/j.braindev.2008.03.010 · 1.54 Impact Factor
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