Correlation of Comorbidities and Variability of Tics in Children with Chronic Tic Disorder.

OBJECTIVE: Chronic tic disorder (CTD) is characterized by the presence of motor and/or phonic tics, and is often accompanied by comorbidities, where obsessive-compulsive disorder (OCD) and attention deficit hyperactivity disorder (ADHD) are the most predominant. The aim of this study was to investigate a correlation between comorbidities and variability of tics in children with CTD. METHOD: A cross-sectional study was completed on a clinical cohort recruited from the Danish National Tourette Clinic at Herlev Hospital. The cohort consisted of 167 children who were examined by the Yale Global Tic Severity Scale. Data regarding comorbidity were collected on 152 of these patients by using validated diagnostic instruments, and the patients were divided into four subgroups: CTD-only, CTD + ADHD, CTD + OCD, and CTD + ADHD + OCD. RESULTS: The comorbidity subgroups had significantly higher severity, impairment, and Total Tic Scores compared to the CTD-only group (p-value ≤ 0.001, 0.001, 0.003, respectively). The assessment of the association between variability of tics and comorbidities showed a significantly higher Simple Phonic Tic Score in the CTD + OCD group compared to the CTD-only group (p-value = 0.003). CONCLUSION: This study showed significantly higher Simple Phonic Tic Scores in the CTD + OCD group compared to the CTD-only group, which suggests that awareness of the variability of tics in patients with CTD and comorbidities is important.Total Tic Scores, severity of tics, and impairment were significantly higher in the comorbidity subgroups compared to the CTD-only group, which support findings from previous studies.

Increased Number of Functional Tics Seen in Danish Adolescents during the COVID-19 Pandemic.

BACKGROUND: Global increase in functional tics in adolescents has been observed. Differentiating functional from classic tics is important since pathophysiology and treatment differ. We investigated possible triggers for development of functional tics and discuss the possible role of the coronavirus disease 2019 (COVID-19) pandemic and social media exposure in cases of functional tics seen during this period. Moreover, the treatment, and its efficacy is discussed. METHODS: Medical records of 28 Danish adolescents diagnosed with functional tics at the National Tourette Clinic, Department of Pediatrics, Herlev University Hospital, Denmark, from May 2020 to June 2021 have been retrospectively reviewed. Descriptive statistical analyses were used to analyze the data. MAIN FINDINGS: A total of 28 patients diagnosed with functional tics were included, 96.4% girls and 3.6% boys, mean age 14.4 years. Tic phenomenology differed from classic tics with more complex tics and no rostrocaudal progression. Note that 69.2% reported harmful tics. Also, 78.6% had trauma/precipitating event and 40% denounced lockdown related to the COVID-19 pandemic as trigger, both prior to onset of functional tics. Note that 60.7% reported psychiatric symptoms/diagnoses, 42.9% had a first-degree family member with psychiatric symptoms/diagnoses, and 96.4% were exposed to tics on social media prior to onset. Treatment consisted of psychoeducation, elements from cognitive behavioral therapy, and focus on psychiatric symptoms. All patients responded to the treatment. CONCLUSION: The vulnerability of the adolescents is characteristic. Treatment strategy has shown immediate positive effect. Consequences of the COVID-19 pandemic in combination with exposure to tics on social media could be part of the cause for the increase in number of functional tics.