Pediatric obsessive–compulsive disorder with tic symptoms: clinical presentation and treatment outcome
- 880 Downloads
Some studies have shown that children and adolescents with obsessive–compulsive disorder (OCD) and co-morbid tics differ from those without co-morbid tics in terms of several demographic and clinical characteristics. However, not all studies have confirmed these differences. This study examined children and adolescents with OCD and with possible or definite tic specifiers according to the DSM-5 in order to see whether they differ from patients without any tic symptoms regarding clinical presentation and outcome of cognitive behavioral therapy (CBT). The full sample included 269 patients (aged 7–17) with primary DSM-IV OCD who had participated in the Nordic Long-term Treatment Study (NordLOTS). Symptoms of tics were assessed using the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS-PL). One or more tic symptoms were found in 29.9% of participants. Those with OCD and co-morbid tic symptoms were more likely male, more likely to have onset of OCD at an earlier age, and differed in terms of OCD symptom presentation. More specifically, such participants also showed more symptoms of OCD-related impairment, externalization, autism spectrum disorder (ASD), social anxiety, and attention-deficit/hyperactivity disorder (ADHD). However, the two groups showed no difference in terms of OCD severity or outcome of CBT. Children and adolescents with OCD and co-morbid tic symptoms differ from those without tic symptoms in several aspects of clinical presentation, but not in their response to CBT. Our results underscore the effectiveness of CBT for tic-related OCD.
Clinical trials registration: Nordic Long-term Obsessive–Compulsive Disorder (OCD) Treatment Study; www.controlled-trials.com; ISRCTN66385119.
KeywordsOCD CBT Pediatric Tics Treatment
The authors would like to thank TrygFonden, Lundbeck Foundation and Central Region Denmark’s Research Fund for supporting the research presented in this article through project Grants.
Compliance with ethical standards
Conflict of interest
Tord Ivarsson: Speaker’s bureau for Shire Sweden. On behalf of all other authors, the corresponding author states that there is no conflict of interest.
- 21.Skarphedinsson G, Melin KH, Valderhaug R et al (2015) Evaluation of the factor structure of the child obsessive-compulsive impact scale—revised (COIS-R) in Scandinavia with confirmatory factor analysis. J Obsessive Compuls Relat Disord 7:65–72. doi: 10.1016/j.jocrd.2015.03.005 CrossRefGoogle Scholar
- 30.Abramovitch A, Dar R, Mittelman A, Wilhelm S (2015) Comorbidity between attention deficit/hyperactivity disorder and obsessive-compulsive disorder across the lifespan: a systematic and critical review. Harv Rev Psychiatry 23:245–262. doi: 10.1097/HRP.0000000000000050 CrossRefPubMedPubMedCentralGoogle Scholar
- 34.Skarphedinsson G, Hanssen-Bauer K, Kornør H et al (2015) Standard individual cognitive behaviour therapy for paediatric obsessive-compulsive disorder: a systematic review of effect estimates across comparisons. Nord J Psychiatry 69:81–92. doi: 10.3109/08039488.2014.941395 CrossRefPubMedGoogle Scholar
- 46.Geller Da, Biederman J, Stewart SE et al (2003) Impact of comorbidity on treatment response to paroxetine in pediatric obsessive-compulsive disorder: is the use of exclusion criteria empirically supported in randomized clinical trials? J Child Adolesc Psychopharmacol 13(Suppl 1):S19–S29. doi: 10.1089/104454603322126313 CrossRefPubMedGoogle Scholar
- 49.Skarphedinsson G, Compton S, Thomsen PH et al (2015) Tics moderate sertraline, but not cognitive-behavior therapy response in pediatric obsessive-compulsive disorder patients who do not respond to cognitive-behavior therapy. J Child Adolesc Psychopharmacol 25:432–439. doi: 10.1089/cap.2014.0167 CrossRefPubMedPubMedCentralGoogle Scholar
- 53.Kaufman J, Birmaher B, Brent D et al (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 36:980–988. doi: 10.1097/00004583-199707000-00021 CrossRefPubMedGoogle Scholar
- 54.Lauth B, Arnkelsson GB, Magnússon P et al (2010) Validity of K-SADS-PL (schedule for affective disorders and schizophrenia for school-age children-present and lifetime version) depression diagnoses in an adolescent clinical population. Nord J Psychiatry 64:409–420. doi: 10.3109/08039481003777484 CrossRefPubMedGoogle Scholar
- 55.Piacentini J, Peris TS, Bergman RL et al (2007) BRIEF REPORT: functional impairment in childhood OCD: development and psychometrics properties of the child obsessive-compulsive impact scale-revised (COIS-R). J Clin Child Adolesc Psychol 36:645–653. doi: 10.1080/15374410701662790 CrossRefPubMedGoogle Scholar
- 56.Achenbach TM, Thomas M (1999) The child behavior checklist and related instruments. In: Mark E. Maruish (ed) use Psychol. Test. Treat. Plan. outcomes Assess., 2 nd edn. Lawrence Erlbaum Associates, Inc, Mahwah, pp 429–466Google Scholar
- 57.Angold A, Costello EJ, Messer SC et al (1995) Development of a short questionnaire for use in epidemiological studies of depression in children and adolescents. Int J Methods Psychiatr Res 5:237–249Google Scholar
- 58.Messer SC, Angold A, Costello JE, Loeber R, Van Kammen W, Stouthamer-Loeber M (1995) Development of a short questionnaire for use in epidemiological studies of depression in children and adolescents: factor composition and structure across development. Int J Methods Psychiatr Res 5:251–262Google Scholar