Course of Tourette Syndrome and Comorbidities in a Large Prospective Clinical Study.
OBJECTIVE
Tourette syndrome (TS) is a childhood-onset neurodevelopmental disorder characterized by tics and frequent comorbidities. Although tics often improve during adolescence, recent studies suggest that comorbid obsessive-compulsive disorder (OCD) and attention-deficit/hyperactivity disorder (ADHD) tend to persist. This large prospective follow-up study describes the clinical course of tics and comorbidities during adolescence and the prevalence of coexisting psychopathologies.


METHODS
The clinical cohort was recruited at the Danish National Tourette Clinic, and data were collected at baseline (n = 314, age range 5-19 years) and at follow-up 6 years later (n = 227) to establish the persistence and severity of tics and comorbidities. During follow-up, the Development and Well-Being Assessment (DAWBA) was used to diagnose coexisting psychopathologies. Repeated measures of severity scores were modeled using mixed effects models.


RESULTS
Tic severity declined yearly (0.8 points, CI: 0.58-1.01, on the Yale Global Tic Severity Scale [YGTSS]) during adolescence; 17.7% of participants above age 16 years had no tics, whereas 59.5% had minimal or mild tics, and 22.8% had moderate or severe tics. Similarly, significant yearly declines in severity of both OCD (0.24, CI: 0.09-0.39, on the Yale-Brown Obsessive Compulsive Scale for Adults [Y-BOCS] and Yale-Brown Obsessive Compulsive Scale for Children [CY-BOCS]) and ADHD (0.42, CI: 0.32-0.52, DSM-IV) were recorded. At follow-up, 63.0% of participants had comorbidities or coexistent psychopathologies, whereas 37.0% had pure TS.


CONCLUSIONS
Severity of tics, OCD, and ADHD were significantly associated with age and declined during adolescence. However, considerable comorbidities and coexisting psychopathologies persist throughout adolescence and require monitoring by clinicians.
Herlev University Hospital, Herlev, Denmark. Electronic address: camilla.groth.jakobsen@gmail.com.
Camilla
C
Groth
Herlev University Hospital, Herlev, Denmark.
Nanette
N
Mol Debes
The Research Clinic for Functional Disorders and Psychosomatics and Child and Adolescent Psychiatric Centre, Risskov, Aarhus University Hospital, Aarhus, Denmark.
Charlotte Ulrikka
CU
Rask
University of Copenhagen and Center for Statistical Science, Peking University, Beijing, China.
Theis
T
Lange
Herlev University Hospital, Herlev, Denmark.
Liselotte
L
Skov
D000293:Adolescent; D000328:Adult; D001289:Attention Deficit Disorder with Hyperactivity / Q000453:epidemiology / Q000503:physiopathology*; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009771:Obsessive-Compulsive Disorder / Q000453:epidemiology / Q000503:physiopathology*; D012720:Severity of Illness Index; D005879:Tourette Syndrome / Q000453:epidemiology / Q000503:physiopathology*; D055815:Young Adult
ADHD; OCD; Tourette syndrome; clinical course; prospective study