title: SUICIDAL THOUGHTS AND BEHAVIORS IN CHILDREN AND ADOLESCENTS WITH CHRONIC TIC DISORDERS.
abstract: OBJECTIVE
  Despite evidence of elevated risk factors for suicidal thoughts and behavior in youth with Tourette syndrome and chronic tic disorders (CTD), few studies have actually examined that relationship. This study documented the frequency and clinical correlates of suicidal thoughts and behaviors in a sample of children and adolescents with CTD (N = 196, range 6-18 years old). The content is solely the responsibility of the authors and does not necessarily represent the official views of the Centers for Disease Control.
  
  
  METHODS
  Youth and parents completed a battery of measures that assessed co-occurring psychiatric diagnoses, child emotional and behavioral symptoms, and impairment due to tics or co-occurring conditions.
  
  
  RESULTS
  A structured diagnostic interview identified that 19 youths with CTD (9.7%) experienced suicidal thoughts and/or behaviors, which was elevated compared to 3 youths (3%) who experienced these thoughts in a community control sample (N = 100, range 6-18 years old, P = .03). For youth with CTD, suicidal thoughts and behaviors were frequently endorsed in the context of anger and frustration. The Child Behavior Checklist (CBCL) anxious/depressed, withdrawn, social problems, thought problems, and aggressive behavior subscales, as well as the total internalizing problems scale, were associated with the presence of suicidal thoughts and/or behaviors. Suicidal thoughts and/or behaviors were significantly associated with tic symptom severity; tic-related impairment; and obsessive-compulsive, depressive, anxiety, and attention-deficit/hyperactivity disorders' symptom severity. CBCL anxiety/depression scores mediated the relationship between tic severity and suicidal thoughts and behaviors.
  
  
  CONCLUSIONS
  Findings suggest that about 1 in 10 youth with CTD experience suicidal thoughts and/or behaviors, which are associated with a more complex clinical presentation and often occur in the presence of anger and frustration.
authors.affiliation: Rothman Center for Neuropsychiatry, Department of Pediatrics, University of South Florida, St. Petersburg, Florida.|Department of Psychiatry & Behavioral Neurosciences, University of South Florida, St. Petersburg, Florida.|Department of Health Policy and Management, University of South Florida, St. Petersburg, Florida.|Rogers Behavioral Health, Tampa Bay, Tampa, Florida.|Department of Psychiatry and Psychology, All Children's Hospital, Johns Hopkins Medicine, St. Petersburg, Florida.
authors.forename: Eric A
authors.initials: EA
authors.lastname: Storch
authors.affiliation: Rothman Center for Neuropsychiatry, Department of Pediatrics, University of South Florida, St. Petersburg, Florida.
authors.forename: Camille E
authors.initials: CE
authors.lastname: Hanks
authors.affiliation: Department of Neurology, University of Rochester, Rochester, New York.|Department of Pediatrics, University of Rochester, Rochester, New York.|Department of Neurobiology & Anatomy, University of Rochester, Rochester, New York.|Department of Brain & Cognitive Sciences, University of Rochester, Rochester, New York.
authors.forename: Jonathan W
authors.initials: JW
authors.lastname: Mink
authors.affiliation: Rothman Center for Neuropsychiatry, Department of Pediatrics, University of South Florida, St. Petersburg, Florida.
authors.forename: Joseph F
authors.initials: JF
authors.lastname: McGuire
authors.affiliation: Department of Neurology, University of Rochester, Rochester, New York.
authors.forename: Heather R
authors.initials: HR
authors.lastname: Adams
authors.affiliation: Department of Neurology, University of Rochester, Rochester, New York.|Department of Pediatrics, University of Rochester, Rochester, New York.
authors.forename: Erika F
authors.initials: EF
authors.lastname: Augustine
authors.affiliation: Department of Neurology, University of Rochester, Rochester, New York.
authors.forename: Amy
authors.initials: A
authors.lastname: Vierhile
authors.affiliation: Department of Neurology, University of Rochester, Rochester, New York.
authors.forename: Alyssa
authors.initials: A
authors.lastname: Thatcher
authors.affiliation: Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Bitsko
authors.affiliation: Rothman Center for Neuropsychiatry, Department of Pediatrics, University of South Florida, St. Petersburg, Florida.|Department of Psychiatry & Behavioral Neurosciences, University of South Florida, St. Petersburg, Florida.
authors.forename: Adam B
authors.initials: AB
authors.lastname: Lewin
authors.affiliation: Rothman Center for Neuropsychiatry, Department of Pediatrics, University of South Florida, St. Petersburg, Florida.|Department of Psychiatry & Behavioral Neurosciences, University of South Florida, St. Petersburg, Florida.|Department of Psychiatry and Psychology, All Children's Hospital, Johns Hopkins Medicine, St. Petersburg, Florida.
authors.forename: Tanya K
authors.initials: TK
authors.lastname: Murphy
mesh_terms: D000293:Adolescent; D001007:Anxiety / Q000523:psychology; D001008:Anxiety Disorders / Q000523:psychology; D001289:Attention Deficit Disorder with Hyperactivity / Q000523:psychology; D002648:Child; D003863:Depression / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D012720:Severity of Illness Index; D059020:Suicidal Ideation; D013981:Tic Disorders / Q000523:psychology*; D005879:Tourette Syndrome / Q000523:psychology
keywords: Tourette syndrome; assessment; children; suicidal ideation; suicide; tic disorder; tics