Subjective versus objective measures of tic severity in Tourette syndrome - The influence of environment.
The objective of this study was to examine the influence of environmental challenges on tic expression by subjective and objective measures. The study group consisted of 41 children aged 6-18 years (M=10.15, SD=2.73) with a primary diagnosis of Tourette syndrome. Subjective measures included the Functional Assessment Interview developed for this study and three standard validated instruments. The objective measure was a video-recording of the patients in five daily-life situations: watching television, doing homework, being alone, receiving attention when ticcing, and talking to a stranger. In addition, the effect of premonitory urges on assessment of tic expression was evaluated. The associations between the subjective and objective measures of tic expression were moderate to low. A significantly higher number of tics were observed in the television situation, and a significantly lower number in the alone situation, compared to the other situations. Higher levels of premonitory urge were associated with greater awareness of objectively measured tic expression. In conclusion, tic expression is significantly influenced by the environment. Subjective measures of tic expression may be misleading. These results have implications for refining the clinical assessment of tics, improving research methodology, and developing new therapeutic strategies.
The Harry Freund Neuro-Psychiatric Clinic, Schneider's Children's Medical Center of Israel, Petach Tikva 49202, Israel; Bar-Ilan University, Ramat Gan 52900, Israel. Electronic address: meiravbarnea@gmail.com.
Meirav
M
Barnea
The Harry Freund Neuro-Psychiatric Clinic, Schneider's Children's Medical Center of Israel, Petach Tikva 49202, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel.
Noa
N
Benaroya-Milshtein
Bar-Ilan University, Ramat Gan 52900, Israel.
Eva
E
Gilboa-Sechtman
Texas A&M University, PO Box 3011, Commerce TX 75429, USA.
Douglas W
DW
Woods
University of California - Los Angeles, Los Angeles CA 90095, USA.
John
J
Piacentini
The Harry Freund Neuro-Psychiatric Clinic, Schneider's Children's Medical Center of Israel, Petach Tikva 49202, Israel.
Silvana
S
Fennig
The Harry Freund Neuro-Psychiatric Clinic, Schneider's Children's Medical Center of Israel, Petach Tikva 49202, Israel.
Alan
A
Apter
The Harry Freund Neuro-Psychiatric Clinic, Schneider's Children's Medical Center of Israel, Petach Tikva 49202, Israel.
Tamar
T
Steinberg
D000293:Adolescent; D001364:Awareness; D002648:Child; D004777:Environment; D005260:Female; D006801:Humans; D008297:Male; D057566:Self Report; D012720:Severity of Illness Index; D012931:Social Environment; D020323:Tics / Q000503:physiopathology*; D005879:Tourette Syndrome / Q000503:physiopathology*; D014741:Video Recording; D014937:Work
Environmental situations; Premonitory urge; Self-report; Tic expression; Video-recording