European Child & Adolescent Psychiatry

, Volume 21, Issue 8, pp 451–457 | Cite as

Tourette syndrome in youth with and without obsessive compulsive disorder and attention deficit hyperactivity disorder

  • Eli R. LebowitzEmail author
  • Maria G. Motlagh
  • Liliya Katsovich
  • Robert A. King
  • Paul J. Lombroso
  • Heidi Grantz
  • Haiqun Lin
  • Mary Jane Bentley
  • Donald L. Gilbert
  • Harvey S. Singer
  • Barbara J. Coffey
  • the Tourette Syndrome Study Group
  • Roger M. Kurlan
  • James F. Leckman
Original Contribution


Chronic tic disorders (TD) are consistently found to have high rates of comorbidity with obsessive–compulsive disorder (OCD) and attention deficit hyperactivity disorder (ADHD). The purpose of this study is to compare the severity of TD only to TD with comorbid OCD or ADHD based on severity of tics, measures of psychopathology and additional comorbid diagnoses. Baseline data from 158 youth with a chronic TD who participated in two longitudinal studies were examined. Fifty-three percent (N = 85) of the youth also met criteria for a diagnosis of OCD, 38.6 % (n = 61) met criteria for ADHD and 24.1 % (N = 38) met criteria for both. Measures of interest addressed severity of tics, symptoms of anxiety, depression, ADHD, psychosocial stress, global functioning and the presence of comorbid diagnoses. Youth with comorbid TD and OCD were characterized by more severe tics, increased levels of depressive and anxious symptoms, heightened psychosocial stress and poorer global functioning. Youth with comorbid TD and ADHD did not differ from those with TD alone on measures of tic severity, but experienced greater psychosocial stress and poorer global functioning. Subjects with comorbid TD and OCD had more internalizing disorders than those without OCD, while those with comorbid ADHD were more likely to meet criteria for oppositional defiant disorder. TD with OCD is a more severe subtype of TD than TD without OCD. TD with ADHD is associated with higher psychosocial stress and more externalizing behaviors. Further research is needed into the underlying relationships between these closely associated conditions.


Tourette’s disorder OCD ADHD Comorbidity 



Eli R. Lebowitz gratefully acknowledges the support of the Messer Anxiety Program at the Yale Child Study Center.

Conflict of interest



  1. 1.
    Ivarsson T, Melin K, Wallin L (2008) Categorical and dimensional aspects of co-morbidity in obsessive–compulsive disorder (OCD). Eur Child Adolesc Psychiatry 17(1):20–31PubMedCrossRefGoogle Scholar
  2. 2.
    Hanna GL (1995) Demographic and clinical features of obsessive–compulsive disorder in children and adolescents. J Am Acad Child Adolesc Psychiatry 34(1):19–27PubMedCrossRefGoogle Scholar
  3. 3.
    Apter A, Pauls DL, Bleich A, Zohar AH, Kron S, Ratzoni G, Dycian A, Kotler M, Weizman A, Gadot N (1993) An epidemiologic study of Gilles de la Tourette’s syndrome in Israel. Arch Gen Psychiatry 50(9):734–738PubMedCrossRefGoogle Scholar
  4. 4.
    Walkup JT, Scahill LD, Riddle MA (1995) Disruptive behavior, hyperactivity, and learning disabilities in children with Tourette’s syndrome. Adv Neurol 65:259–272PubMedGoogle Scholar
  5. 5.
    Kurlan R, Como PG, Miller B, Palumbo D, Deeley C, Andresen EM, Eapen S, McDermott MP (2002) The behavioral spectrum of tic disorders: a community-based study. Neurology 59(3):414–420PubMedCrossRefGoogle Scholar
  6. 6.
    Leckman JF, Denys D, Simpson HB, MataixCols D, Hollander E, Saxena S, Miguel EC, Rauch SL, Goodman WK, Phillips KA, Stein DJ (2010) Obsessive–compulsive disorder: a review of the diagnostic criteria and possible subtypes and dimensional specifiers for DSM-V. Depress Anxiety 27(6):507–527PubMedCrossRefGoogle Scholar
  7. 7.
    Sheppard DM, Bradshaw JL, Purcell R, Pantelis C (1999) Tourette’s and comorbid syndromes: obsessive compulsive and attention deficit hyperactivity disorder. A common etiology? Clin Psychol Rev 19(5):531–552PubMedCrossRefGoogle Scholar
  8. 8.
    Albin RL, Mink JW (2006) Recent advances in Tourette syndrome research. Trends Neurosci 29(3):175–182PubMedCrossRefGoogle Scholar
  9. 9.
    Cherkasova MV, Hechtman L (2009) Neuroimaging in attention–deficit hyperactivity disorder: beyond the frontostriatal circuitry. Can J Psychiatry 54(10):651–664PubMedGoogle Scholar
  10. 10.
    Sachdev PS, Malhi GS (2005) Obsessive–compulsive behaviour: a disorder of decision-making. Aust N Z J Psychiatry 39(9):757–763PubMedGoogle Scholar
  11. 11.
    Marsh R, Maia TV, Peterson BS (2009) Functional disturbances within frontostriatal circuits across multiple childhood psychopathologies. Am J Psychiatry 166(6):664–674PubMedCrossRefGoogle Scholar
  12. 12.
    Grados MA (2010) The genetics of obsessive–compulsive disorder and Tourette syndrome: an epidemiological and pathway-based approach for gene discovery. J Am Acad Child Adolesc Psychiatry 49(8):810–819PubMedCrossRefGoogle Scholar
  13. 13.
    Pauls DL (1992) The genetics of obsessive compulsive disorder and Gilles de la Tourette’s syndrome. Psychiatr Clin North Am 15(4):759–766PubMedGoogle Scholar
  14. 14.
    Pauls DL, Towbin KE, Leckman JF, Zahner GE, Cohen DJ (1986) Gilles de la Tourette’s syndrome and obsessive–compulsive disorder. Evidence supporting a genetic relationship. Arch Gen Psychiatry 43(12):1180–1182PubMedCrossRefGoogle Scholar
  15. 15.
    Stewart SE, Illmann C, Geller DA, Leckman JF, King R, Pauls DL (2006) A controlled family study of attention-deficit/hyperactivity disorder and Tourette’s disorder. J Am Acad Child Adolesc Psychiatry 45(11):1354–1362PubMedCrossRefGoogle Scholar
  16. 16.
    Comings DE, Comings BG (1984) Tourette’s syndrome and attention deficit disorder with hyperactivity: are they genetically related? J Am Acad Child Psychiatry 23(2):138–146PubMedCrossRefGoogle Scholar
  17. 17.
    Pauls DL, Hurst CR, Kruger SD, Leckman JF, Kidd KK, Cohen DJ (1986) Gilles de la Tourette’s syndrome and attention deficit disorder with hyperactivity. Evidence against a genetic relationship. Arch Gen Psychiatry 43(12):1177–1179PubMedCrossRefGoogle Scholar
  18. 18.
    O’Rourke JA, Scharf JM, Platko J, Stewart SE, Illmann C, Geller DA, King RA, Leckman JF, Pauls DL (2011) The familial association of Tourette’s disorder and ADHD: the impact of OCD symptoms. Am J Med Genet B Neuropsychiatr Genet 156(5):553–560CrossRefGoogle Scholar
  19. 19.
    Coffey BJ, Miguel EC, Biederman J, Baer L, Rauch SL, O’Sullivan RL, Savage CR, Phillips K, Borgman A, Green-Leibovitz MI, Moore E, Park KS, Jenike MA (1998) Tourette’s disorder with and without obsessive–compulsive disorder in adults: are they different? J Nerv Ment Dis 186(4):201–206PubMedCrossRefGoogle Scholar
  20. 20.
    Wanderer S, Roessner V, Freeman R, Bock N, Rothenberger A, Becker A (2012) Relationship of obsessive–compulsive disorder to age-related comorbidity in children and adolescents with Tourette syndrome. J Dev Behav Pediatr 33(2):124–133PubMedGoogle Scholar
  21. 21.
    Lewin AB, Chang S, McCracken J, McQueen M, Piacentini J (2010) Comparison of clinical features among youth with tic disorders, obsessive–compulsive disorder (OCD), and both conditions. Psychiatry Res 178(2):317–322PubMedCrossRefGoogle Scholar
  22. 22.
    Tukel R, Polat A, Ozdemir O, Aksut D, Turksoy N (2002) Comorbid conditions in obsessive–compulsive disorder. Compr Psychiatry 43(3):204–209PubMedCrossRefGoogle Scholar
  23. 23.
    Sukhodolsky DG, Scahill L, Zhang H, Peterson BS, King RA, Lombroso PJ, Katsovich L, Findley D, Leckman JF (2003) Disruptive behavior in children with Tourette’s syndrome: association with ADHD comorbidity, tic severity, and functional impairment. J Am Acad Child Adolesc Psychiatry 42(1):98–105PubMedCrossRefGoogle Scholar
  24. 24.
    Carter AS, O’Donnell DA, Schultz RT, Scahill L, Leckman JF, Pauls DL (2000) Social and emotional adjustment in children affected with Gilles de la Tourette’s syndrome: associations with ADHD and family functioning. J Child Psychol Psychiatry 41(2):215–223PubMedCrossRefGoogle Scholar
  25. 25.
    Spencer T, Biederman J, Coffey B, Geller D, Wilens T, Faraone S (1999) The 4-year course of tic disorders in boys with attention-deficit/hyperactivity disorder. Arch Gen Psychiatry 56(9):842–847PubMedCrossRefGoogle Scholar
  26. 26.
    Roessner V, Becker A, Banaschewski T, Freeman RD, Rothenberger A (2007) Developmental psychopathology of children and adolescents with Tourette syndrome–impact of ADHD. Eur Child Adolesc Psychiatry 16(Suppl 1):24–35. doi: 10.1007/s00787-007-1004-6 PubMedCrossRefGoogle Scholar
  27. 27.
    Dykens E, Leckman J, Riddle M, Hardin M, Schwartz S, Cohen D (1990) Intellectual, academic, and adaptive functioning of Tourette syndrome children with and without attention deficit disorder. J Abnorm Child Psychol 18(6):607–615PubMedCrossRefGoogle Scholar
  28. 28.
    Haddad ADM, Umoh G, Bhatia V, Robertson MM (2009) Adults with Tourette’s syndrome with and without attention deficit hyperactivity disorder. Acta Psychiatr Scand 120(4):299–307PubMedCrossRefGoogle Scholar
  29. 29.
    Leckman J, King R, Gilbert D, Coffey B, Singer H, Dure L, Grantz H, Katsovich L, Lin H, Lombroso P, Kawikova I, Johnson D, Kurlan R, Kaplan E (2011) Streptococcal upper respiratory tract infections and exacerbations of tic and obsessive–compulsive symptoms: a prospective longitudinal study. J Am Acad Child Adolesc Psychiatry 50(2):108–118PubMedCrossRefGoogle Scholar
  30. 30.
    Kurlan R, Johnson D, Kaplan E (2008) Streptococcal infection and exacerbations of childhood tics and obsessive–compulsive symptoms: a prospective blinded cohort study. Pediatrics 121(6):1188–1197PubMedCrossRefGoogle Scholar
  31. 31.
    Swedo SE, Leonard HL, Garvey M, Mittleman B, Allen AJ, Perlmutter S, Lougee L, Dow S, Zamkoff J, Dubbert BK (1998) Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections: clinical description of the first 50 cases. Am J Psychiatry 155(2):264–271PubMedGoogle Scholar
  32. 32.
    American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders: DSM-IV-tr, 4th edn. American Psychiatric Association, WashingtonGoogle Scholar
  33. 33.
    Shaffer D, Fisher P, Lucas CP, Dulcan MK, Schwab-Stone ME (2000) NIMH diagnostic interview schedule for children version IV (NIMH DISC-IV): description, differences from previous versions, and reliability of some common diagnoses. J Am Acad Child Adolesc Psychiatry 39(1):28–38PubMedCrossRefGoogle Scholar
  34. 34.
    Leckman JF, Riddle MA, Hardin MT, Ort SI, Swartz KL, Stevenson J, Cohen DJ (1989) The Yale Global Tic Severity Scale: initial testing of a clinician-rated scale of tic severity. J Am Acad Child Adolesc Psychiatry 28(4):566–573PubMedCrossRefGoogle Scholar
  35. 35.
    Scahill L, Riddle MA, McSwigginHardin M, Ort SI (1997) Children’s Yale-Brown Obsessive Compulsive Scale: reliability and validity. J Am Acad Child Adolesc Psychiatry 36(6):844–852PubMedCrossRefGoogle Scholar
  36. 36.
    DuPaul GJ (1991) Parent and teacher ratings of ADHD symptoms: psychometric properties in a community-based sample. J Clin Child Psychol 20(3):245–253CrossRefGoogle Scholar
  37. 37.
    March J (1997) The multidimensional anxiety scale for children (MASC): factor structure, reliability, and validity. J Am Acad Child Adolesc Psychiatry 36(4):554–565PubMedCrossRefGoogle Scholar
  38. 38.
    Kovacs M (1985) The Children’s Depression Inventory (CDI). Psychopharmacol Bull 21(4):995–998PubMedGoogle Scholar
  39. 39.
    Kaufman J, Birmaher B, Brent D, Rao U, Flynn C, Moreci P, Williamson D, Ryan N (1997) Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime version (K-SADS-PL): initial reliability and validity data. J Am Acad Child Adolesc Psychiatry 36(7):980–988PubMedCrossRefGoogle Scholar
  40. 40.
    Cohen S, Kamarck T, Mermelstein R (1983) A global measure of perceived stress. J Health Soc Behav 24(4):385–396PubMedCrossRefGoogle Scholar
  41. 41.
    Shaffer D, Gould MS, Brasic J, Ambrosini P, Fisher P, Bird H, Aluwahlia S (1983) A Children’s Global Assessment Scale (CGAS). Arch Gen Psychiatry 40(11):1228PubMedCrossRefGoogle Scholar
  42. 42.
    Kadesjö B, Gillberg C (2000) Tourette’s disorder: epidemiology and comorbidity in primary school children. J Am Acad Child Adolesc Psychiatry 39(5):548–555PubMedCrossRefGoogle Scholar
  43. 43.
    Freeman RD (2000) An international perspective on Tourette syndrome: selected findings from 3,500 individuals in 22 countries. Dev Med Child Neurol 42(7):436–447PubMedCrossRefGoogle Scholar
  44. 44.
    Pitman RK (1987) Pierre Janet on obsessive–compulsive disorder (1903). Review and commentary. Arch Gen Psychiatry 44(3):226–232PubMedCrossRefGoogle Scholar
  45. 45.
    Palumbo D, Kurlan R (2007) Complex obsessive compulsive and impulsive symptoms in Tourette’s syndrome. Neuropsychiatr Dis Treat 3(5):687–693PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Eli R. Lebowitz
    • 1
    Email author
  • Maria G. Motlagh
    • 1
  • Liliya Katsovich
    • 1
  • Robert A. King
    • 1
  • Paul J. Lombroso
    • 1
  • Heidi Grantz
    • 1
  • Haiqun Lin
    • 2
  • Mary Jane Bentley
    • 1
  • Donald L. Gilbert
    • 3
  • Harvey S. Singer
    • 4
  • Barbara J. Coffey
    • 5
  • the Tourette Syndrome Study Group
  • Roger M. Kurlan
    • 6
  • James F. Leckman
    • 1
  1. 1.Yale Child Study CenterNew HavenUSA
  2. 2.Yale UniversityNew HavenUSA
  3. 3.Division of Neurology at the Cincinnati Children’s Hospital Medical CenterUniversity of Cincinnati Medical SchoolCincinnatiUSA
  4. 4.Johns Hopkins University School of MedicineBaltimoreUSA
  5. 5.Child Study Center at the New York University School of MedicineNew YorkUSA
  6. 6.Atlantic Neuroscience Institute, Overlook HospitalSummitUSA

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