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Table 2 Comorbidities in TS from studies based on clinical samples

From: Tourette syndrome and other neurodevelopmental disorders: a comprehensive review

Author (year)

N

Age

Methods used to evaluated comorbidities

Comorbidity prevalence rate

Main findings

Nationality

Comings and Comings (1987) [32]

246

Mean, 18.2

DSM III-based questionnaire

ADHD 48.8%

ADD 11.8%

Dyslexia 27%

TS patients have a significant risk for school problems and increased rate of dyslexia

USA

Chee et al. (1994) [54]

50

Mean, 20.8

Structured NS interview

ADHD 32%

Depression 18%

Anxiety 30%

Rate of prevalence of TS and comorbidities in an Australian TS cohort

Australia

Abwender et al. (1996) [55]

138

Children

NS

LD 22%

School difficulties are associated with comorbid ADHD

USA

Cardoso et al. (1996) [56]

32

Mean, 24

DSM IV criteria

ADHD NS 63%

OCD 44%

Sleep disorders 53%

Depression 31%

Impulse control deficit 28%

Rate of prevalence of TS and comorbidities in a Brazilian TS cohort

Brazil

Schuerholz et al. (1996) [57]

65

6–14

NS

LD 23%

LD is strongly correlated to the presence of ADHD

USA

Yeates et al. (1996) [34]

70

6–18

WRAT-R

WCST

HRB

HRB

WISC-R

Deficit in arithmetic 14/70 (20%)

Deficit in reading (14%)

General academic deficit (29%)

TS children classified in different learning disability subtypes reveal significant differences in neuropsychological functioning

USA

Wodrich et al. (1997) [58]

33

Children

DSM III criteria

ADHD NS 55%

Depression 73%

Conduct problems 18%

Prevalence and manifestations of comorbidities of TS patients in psychiatry practice are not identical to those reported in the literature

USA

Kano et al. (1998) [59]

64

Mean, 17.4

DSM III-R criteria

ADHD NS 17.2%

OCD 62.5%

Rate of coprolalia in Japan is higher than the previously reported rate, and TS is often associated with developmental disorders

Japan

Freeman et al. (2000) [36]

3500

NS

DSM III/IV criteria

ADHD HI 7%

ADHD C 51%

ADHD PI 37%

PDD 4.6%

OCD 22.3%

Mood disorder 16.9%

Anxiety disorder 16.8%

ID 3.4%

Anger 27.6%

Sleep problem 17.8%

ADHD is associated with an earlier diagnosis of TS and a higher rate of comorbidities (with the exception of anxiety disorders)

One-third of TS + ADHD cases have LD, 26% have social skill deficits, and 39% have problems controlling anger

International database (author from Canada)

Teive et al. (2001) [33]

44 CTD (75% TS)

3–60

DSM IV criteria

ADHD 38.6%

OCD 59.1%

Affective disorders 11%

Anxiety disorder 9%

LD 14%

Sleep disorder 9%

Behavioural disorder 7%

Rate of comorbidities in a Brazilian clinical cohort

Brazil

Burd et al. (2005) [35]

5450

NS

DSM IV criteria

LD 22.7%

ADHD NS 58%

In TS + LD, 80.2% patients also have ADHD and in the TS − LD group, 51.3% have ADHD; 31% of subjects with ADHD have also a diagnosis of LD

TIC international database (author from USA)

Saccomani et al. (2005) [60]

48

Mean, 11.2

DSM IV criteria

ADHD ns 43.8%

OCD 54.2%

Anxiety disorders 2.1%

Sleep problems 27.1%

Mood disorders 18.8%

Rate of comorbidities and clinical features of an Italian clinical cohort

Italy

Termine et al. (2006) [61]

17

Mean, 11.4

CBCL

Conners

SAFA

K-SADS

YGTSS

ADHD ns 11.8%

ADHD ns + OCD 23.5%

OCD 41.2%

TS patients have a high prevalence of ADHD and OCD compared with controls

Italy

Janik et al. (2007) [62]

126

Mean, 7.6

NS

ADHD ns 59%

Rate of comorbidities and clinical features of a Polish clinical cohort

Poland

Roessner et al. (2007) [63]

5060 (TIC database)

NS

DSM IV criteria

ADHD ns 61.2%

Comorbid ADHD is associated with high rates of externalising and internalising problems

International database (author from Germany)

Robertson et al. (2008) [64]

410

3–59

DSM IV criteria

NHIS

ADHD 56% (230/410)

Factor analytic study. TS can be disaggregated into more homogeneous symptom components

USA

Ghanizadeh et al. (2009) [65]

35

Mean, 11.8

CBCL

K-SADS

YGTSS

ASD 2.9%

ADHD 68.6%

Rate of comorbidities and clinical features of an Iranian clinical cohort

Iran

Gorman et al. (2010) [66]

65

Mean, 18

CBCL

K-SADS

CGAS

CYBOCS

Vineland

YGTSS

ADHD 43%

LD 27%

OCD 25%

Conduct disorder 15%

Major depressive disorder 40%

Tic and ADHD severity are associated with a poorer psychosocial outcome

USA

Specht et al. (2011) [28]

126 (93.7% TS)

Mean, 11.7

ADIS-RLV

CBCL

CGI-S

YGTSS

CGAS

ADHD ns 26%

Social phobia 21%

Anxiety disorder 20%

OCD 19%

In a sample of youth seeking treatment for a chronic tic disorder, ADHD is much lower than in clinically ascertained case series

USA

Lebowitz et al. (2012) [29]

158 CTD (143 TS)

6–14.5

Conners

ASQ-P

DISC IV

CYBOCS

MASC

YGTSS

CGAS

ADHD 38.6%

OCD 53.8%

ADHD + OCD 24.1%

TD with comorbid ADHD is associated with higher psychosocial stress and more externalising behaviours

USA

Rizzo et al. (2014) [67]

92

7–17

Conners

DSM IV/V criteria

CBCL

MASC

CDI

YQLI-RV

WISC-III

ADHD 22.2%

ADHD + OCD 6.5%

OCD 21.5%

TS + comorbidity patients have overrepresented affective and anxiety symptoms

Italy

Byler (2015) [30]

482

Two evaluation

Mean, 9.8

NS

ADHD 40% (first evaluation) + 21% (second evaluation)

LD 5.4%

Asperger 3% (first) + 2.1% (second)

OCD 17% (first) + 14% (second evaluation)

Survey:

ADHD ns 41%, OCD 42%, LD 26.5%

More than 40% of TS patients continued to report ADHD or OCD as adults

USA

Hirschtritt et al. (2015) [9]

1374

Mean, 19.1

K-SADS

DSM-IV structured interview

ADHD ns 54.3%

OCD 66%

Mood disorders 30%

Disruptive behaviour 30%

Anxiety 32%

ADHD began before tic onset and increased the presence of other comorbidities

USA

Canada

Great Britain

Netherlands

Eapen et al. (2016) [12]

83

N = 43 < 18 

N = 40 > 18

NHIS

YGTSS

HR-QoL

ADHD ns 21%

LD 24%

ASD 15%

OCD 35%

Anxiety disorder 45%

Depressive disorders 33%

Conduct disorder 4.8%

Presence of comorbidities and ADHD, in particular, has a greater impact on quality of life

Australia

Huisman-van Dijk et al. (2016) [11]

225

6–72

Conners

AQ

SCID-I

CYBOCS

YGTSS

ADHD 26%

ASD 20%

OCD 35.9%

Exploratory factor analyses (EFA) reveal a five-factor structure

Germany

Sambrani et al. (2016) [26]

1032 CTD (978 TS)

N = 529 < 18 

N = 503 > 18

DSM IV criteria

ADHD 45%

Hyperactivity 28.4%

Inattention 39.4%

OCD 10%

Sleeping problems 27%

Anxiety 31%

Depression 23%

Comorbid ADHD reduces the patients’ ability for tic suppression

Germany

  1. ADD, attention deficit disorder; ADHD, attention deficit/hyperactivity disorder; ADHD C, ADHD combined; ADHD HI, ADHD hyperactive; ADHD PI, ADHD predominantly inattentive; ADHD HADIS-RLV, anxiety disorders interview schedule for DSMIV: research and lifetime version for children and parents; ASD, autism spectrum disorder; ASQ, autism screening questionnaire; ASQ-P, Conners abbreviated symptom questionnaire-parent; ASSQ, autism spectrum screening questionnaire; AQ, autism-spectrum quotient; CBCL, child behavior checklist; CDI, children’s depression inventory; CGAS, children’s global assessment scale; CGI-S, clinical global impression-severity scale; CTD, chronic tic disorder; CYBOCS, children’s Yale-brown obsessive compulsive scale; DISC IV, diagnostic interview schedule for children; GTS-QOL, Gilles de la Tourette syndrome-quality of life scale; HRB, Halstead-retain neuropsychological test battery; ID, intellectual disability; K-SADS, Kiddie schedule for affective disorders and schizophrenia; LD, learning disorder; MASC, multidimensional anxiety scale for children; NHIS, national hospital interview schedule; NS, not specified; OCD, obsessive compulsive disorder; PDD, pervasive developmental disorder; PIC, personality inventory for children; SAFA, self administrated psychiatric scales for children and adolescents; SCID, structured clinical interview; STSS, Shapiro Tourette syndrome severity; TS, Tourette syndrome; WCST, Wisconsin card sorting test; WISC-R, Wechsler intelligence scale for children-revised; WRAT-R, wide range achievement test-revised; YGTSS, Yale global tic severity scale; YQLI-RV, youth quality of life-research; YSTSOBS, Yale schedule for Tourette’s syndrome and other behavioral syndromes