European Child & Adolescent Psychiatry

, Volume 22, Issue 3, pp 185–192 | Cite as

Emotional development in children with tics: a longitudinal population-based study

  • P. J. Hoekstra
  • A. J. Lundervold
  • S. A. Lie
  • C. Gillberg
  • Kerstin J. PlessenEmail author
Original Contribution


Children with tics often experience accompanying problems that may have more impact on their well being and quality of life than the tics themselves. The present study investigates characteristics and the course of associated problems. In a population-based follow-up study, we investigated the developmental trajectory of children with and without tics when they were 7–9 years old. Parents and teachers completed the Strengths and Difficulties Questionnaire (SDQ) when the children were 7–9 years (wave 1) and 4 years later (wave 2). Using strict criteria, we identified 38 children with tics in the cohort of 4,025 children (0.94 % of the total cohort) with a preponderance of boys (78.9 %). 22 children (57.9 %) in the group with tics had only motor tics, and 16 (42.1 %) had both motor and vocal tics. Children with tics had significantly higher parent- and teacher-rated SDQ total difficulty scores and subscale scores in both waves. Children with tics experienced an increase in emotional problems and in peer problems between the first and the second wave. This study in a general population indicates that the presence of tics is associated with a range of internalizing and externalizing difficulties, as well as problems in peer relationships. Moreover, our study indicates that emotional and peer problems tend to increase over time in the group of children with tics.


Tics Population-based Emotional problems Development 



We greatly appreciate the participants of the present study and the project group of the Bergen Child Study. The study was supported by the Norwegian Directorate for Health and Social Affairs, the Norwegian Research Council, Western Norway Regional Health Authority (MoodNet), the City of Bergen, and Uni Research.

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Robertson MM (2006) Mood disorders and Gilles de la Tourette’s syndrome: an update on prevalence, etiology, comorbidity, clinical associations, and implications. J Psychosom Res 61:349–358PubMedCrossRefGoogle Scholar
  2. 2.
    Gilles de la Tourette G (1885) Étude sur une affection nerveuse caracterisée par l’incoordination motrice accompagnée d’écholalie et de coprolalie 1885. Archives de Neurologie 9:19–42, 158-200Google Scholar
  3. 3.
    Bernard BA, Stebbins GT, Siegel S et al (2009) Determinants of quality of life in children with Gilles de la Tourette syndrome. Mov Disord 24:1070–1073PubMedCrossRefGoogle Scholar
  4. 4.
    Freeman RD, Fast DK, Burd L, Kerbeshian J, Robertson MM, Sandor P (2000) An international perspective on Tourette syndrome: selected findings from 3,500 individuals in 22 countries. Dev Med Child Neurol 42:436–447PubMedCrossRefGoogle Scholar
  5. 5.
    Kadesjö B, Gillberg C (2000) Tourette’s disorder: epidemiology and comorbidity in primary school children. J Am Acad Child Adolesc Psychiatry 39:548–555PubMedCrossRefGoogle Scholar
  6. 6.
    Khalifa N, von Knorring AL (2006) Psychopathology in a Swedish population of school children with tic disorders. J Am Acad Child Adolesc Psychiatry 45:1346–1353PubMedCrossRefGoogle Scholar
  7. 7.
    Bloch MH, Peterson BS, Scahill L et al (2006) Adulthood outcome of tic and obsessive-compulsive symptom severity in children with Tourette syndrome. Arch Pediatr Adolesc Med 160:65–69PubMedCrossRefGoogle Scholar
  8. 8.
    Leckman JF, Zhang H, Vitale A et al (1998) Course of tic severity in Tourette syndrome: the first two decades. Pediatrics 102:14–19PubMedCrossRefGoogle Scholar
  9. 9.
    Spencer T, Biederman M, 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 56:842–847PubMedCrossRefGoogle Scholar
  10. 10.
    Pappert EJ, Goetz CG, Louis ED, Blasucci L, Leurgans S (2003) Objective assessments of longitudinal outcome in Gilles de la Tourette’s syndrome. Neurology 61:936–940PubMedCrossRefGoogle Scholar
  11. 11.
    Gorman DA, Thompson N, Plessen KJ, Robertson MM, Leckman JF, Peterson BS (2010) Psychosocial outcome and psychiatric comorbidity in older adolescents with Tourette syndrome: controlled study. Br J Psychiatry 197:36–44PubMedCrossRefGoogle Scholar
  12. 12.
    Apter A, Pauls DL, Bleich A et al (1992) A population-based epidemiological study of Tourette syndrome among adolescents in Israel. Adv Neurol 58:61–65PubMedGoogle Scholar
  13. 13.
    Goodman R (1999) The extended version of the Strengths and Difficulties Questionnaire as a guide to child psychiatric caseness and consequent burden. J Child Psychol Psychiatry 40:791–799PubMedCrossRefGoogle Scholar
  14. 14.
    Goodman R (2001) Psychometric properties of the strengths and difficulties questionnaire. J Am Acad Child Adolesc Psychiatry 40:1337–1345PubMedCrossRefGoogle Scholar
  15. 15.
    Heiervang E, Stormark KM, Lundervold AJ et al (2007) Psychiatric disorders in Norwegian 8-to 10-year-olds: an epidemiological survey of prevalence, risk factors, and service use. J Am Acad Child Adolesc Psychiatry 46:438–447PubMedCrossRefGoogle Scholar
  16. 16.
    Stormark KM, Heiervang E, Heimann M, Lundervold AJ, Gillberg C (2008) Predicting nonresponse bias from teacher ratings of mental health problems in primary school children. J Abnorm Child Psychol 36:411–419PubMedCrossRefGoogle Scholar
  17. 17.
    Obel C, Heiervang E, Rodriguez A et al (2004) The Strengths and Difficulties Questionnaire in the Nordic countries. Eur Child Adolesc Psychiatry 13:32–39CrossRefGoogle Scholar
  18. 18.
    Roessner V, Becker A, Banaschewski T, Freeman RD, Rothenberger A, Tourette Syndrome International Database Consortium (2007) Developmental psychopathology of children and adolescents with Tourette syndrome–impact of ADHD. Eur Child Adolesc Psychiatry 16:24–35PubMedCrossRefGoogle Scholar
  19. 19.
    Pollak Y, Benarroch F, Kanengisser L et al (2009) Tourette syndrome-associated psychopathology: roles of comorbid attention-deficit hyperactivity disorder and obsessive-compulsive disorder. J Dev Behav Pediatr 30:413–419PubMedCrossRefGoogle Scholar
  20. 20.
    Cohen E, Sade M, Benarroch F, Pollak Y, Gross-Tsur V (2008) Locus of control, perceived parenting style, and symptoms of anxiety and depression in children with Tourette’s syndrome. Eur Child Adolesc Psychiatry 17:299–305PubMedCrossRefGoogle Scholar
  21. 21.
    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 33:124–133PubMedGoogle Scholar
  22. 22.
    Peterson BS, Pine DS, Cohen P, Brook JS (2001) Prospective, longitudinal study of tic, obsessive–compulsive, and attention-deficit/hyperactivity disorders in an epidemiological sample. J Am Acad Child Adolesc Psychiatry 40:685–695PubMedCrossRefGoogle Scholar
  23. 23.
    Khalifa N, von Knorring AL (2005) Tourette syndrome and other tic disorders in a total population of children: clinical assessment and background. Acta Paediatr 94:1608–1614PubMedCrossRefGoogle 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. Attention Deficit Hyperactivity Disorder. J Child Psychol Psychiatry 41:215–223PubMedCrossRefGoogle Scholar
  25. 25.
    O’Rourke JA, Scharf JM, Yu D, Pauls DL (2009) The genetics of Tourette syndrome: a review. J Psychosom Res 67(6):533–545PubMedCrossRefGoogle Scholar
  26. 26.
    Freeman RD, Fast DK, Burd L, Kerbeshian J, Robertson MM, Sandor P, International Database Consortium (2000) An international perspective on Tourette syndrome: selected findings from 3500 individuals in 22 countries. Dev Med Child Neurol 42:436–447PubMedCrossRefGoogle Scholar
  27. 27.
    Bloch MH, Peterson BS, Scahill L, Otka J, Katsovich L, Zhang H, Leckman JF (2006) Adulthood outcome of tic and obsessive–compulsive symptom severity in children with Tourette syndrome. Arch Pediatr Adolesc Med 160(1):65–69PubMedCrossRefGoogle Scholar
  28. 28.
    Stokes A, Bawden HN, Camfield PR, Backman JE, Dooley JM (1991) Peer problems in Tourette’s disorder. Pediatrics 87:936–942PubMedGoogle Scholar
  29. 29.
    Salbach-Andrae H, Lenz K, Lehmkuhl U (2009) Patterns of agreement among parent, teacher and youth ratings in a referred sample. Eur Psychiatry 24:345–351PubMedCrossRefGoogle Scholar
  30. 30.
    Robertson MM (2008) The prevalence and epidemiology of Gilles de la Tourette syndrome. Part 1: the epidemiological and prevalence studies. J Psychosom Res 65:461–472PubMedCrossRefGoogle Scholar
  31. 31.
    Woods DW, Marcks BA (2005) Controlled evaluation of an educational intervention used to modify peer attitudes and behavior toward persons with Tourette’s Syndrome. Behav Modif 29:900–912PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  • P. J. Hoekstra
    • 1
  • A. J. Lundervold
    • 2
    • 3
  • S. A. Lie
    • 3
  • C. Gillberg
    • 3
    • 4
  • Kerstin J. Plessen
    • 5
    • 6
    • 7
    Email author
  1. 1.Department of Psychiatry, University Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
  2. 2.Department of Biological and Medical PsychologyUniversity of BergenBergenNorway
  3. 3.Centre for Child and Adolescent Mental Health and Welfare, Uni HealthBergenNorway
  4. 4.Gillberg Neuropsychiatry Center, Salgrenska AcademyUniversity of GothenburgGothenburgSweden
  5. 5.Institute for Neurology, Psychiatry and Sensory SciencesUniversity of CopenhagenCopenhagenDenmark
  6. 6.Department of Clinical MedicineUniversity of BergenBergenNorway
  7. 7.Mental Health Centre for Child and Adolescent PsychiatryCopenhagen NVDenmark

Personalised recommendations