Skip to main content

Academic, Interpersonal, Recreational, and Family Impairment in Children with Tourette Syndrome and Attention-Deficit/Hyperactivity Disorder

Abstract

This study describes impairment in academic, interpersonal, recreational, and family financial or occupational domains across children in three mutually exclusive diagnostic groups: ever diagnosed with Tourette syndrome (TS), attention-deficit/hyperactivity disorder (ADHD), and both disorders. In 2014, parents reported on impairment and diagnostic status of children aged 4–17 years (n = 3014). Weighted analysis and pairwise t-tests showed more children with ADHD (with or without TS) experienced impairment in overall school performance, writing, and mathematics, relative to children with TS but not ADHD. More children with TS and ADHD had problematic handwriting relative to children with ADHD but not TS. More children with TS and ADHD had problematic interpersonal relationships relative to those with ADHD but not TS. Children with TS and ADHD had higher mean impairment across domains than children with either TS or ADHD. Findings suggest assessing disorder-specific contributions to impairment could inform targeted interventions for TS and ADHD.

This is a preview of subscription content, access via your institution.

Notes

  1. 1.

    ADD: Attention Deficit Disorder.

  2. 2.

    The dataset for NS-DATA ADHD module is publicly available; the TS module requires a data agreement with the National Center for Health Statistics’ Research Data Center. More information about accessing the NS-DATA datasets can be found at www.cdc.gov/nchs/slaits/ns_data.htm and www.cdc.gov/rdc.

References

  1. 1.

    Banaschewski T, Neale BM, Rothenberger A, Roessner V (2007) Comorbidity of tic disorders & ADHD: conceptual and methodological considerations. Eur Child Adolesc Psychiatry 16:5–14

    PubMed  Article  PubMed Central  Google Scholar 

  2. 2.

    American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders, 5th edn. American Psychiatric Publishing, Arlington, VA

    Book  Google Scholar 

  3. 3.

    El Malhany N, Gulisano M, Rizzo R, Curatolo P (2015) Tourette syndrome and comorbid ADHD: causes and consequences. Eur J Pediatr 174:279–288

    PubMed  Article  PubMed Central  Google Scholar 

  4. 4.

    Bitsko RH, Holbrook JR, Visser SN, Mink JW, Zinner SH, Ghandour RM et al (2014) A national profile of Tourette syndrome, 2011–2012. J Dev Behav Pediatr 35:317–322

    PubMed  PubMed Central  Article  Google Scholar 

  5. 5.

    Danielson ML, Bitsko RH, Ghandour RM, Holbrook JR, Kogan MD, Blumberg SJ (2018) Prevalence of parent-reported ADHD diagnosis and associated treatment among U.S. children and adolescents, 2016. J Clin Child Adoles Psychol 47:199–212

    Article  Google Scholar 

  6. 6.

    Scharf JM, Miller LL, Gauvin CA, Alabiso J, Mathews CA, Ben-Shlomo Y (2015) Population prevalence of Tourette syndrome: a systematic review and meta-analysis. Mov Disord 30:221–228

    PubMed  Article  PubMed Central  Google Scholar 

  7. 7.

    Wolraich ML, McKeown RE, Visser SN, Bard D, Cuffe S, Neas B et al (2014) The prevalence of ADHD: Its diagnosis and treatment in four school districts across two states. J Atten Disord 18:563–575

    PubMed  Article  PubMed Central  Google Scholar 

  8. 8.

    Danckaerts M, Sonuga-Barke EJS, Banaschewski T, Buitelaar J, Döpfner M, Hollis C et al (2010) The quality of life of children with attention deficit/hyperactivity disorder: a systematic review. Eur Child Adolesc Psychiatry 19:83–105

    PubMed  Article  PubMed Central  Google Scholar 

  9. 9.

    Claussen AH, Bitsko RH, Holbrook JR, Bloomfield J, Giordano K (2018) Impact of Tourette syndrome on school measures in a nationally representative sample. J Dev Behav Pediatr 39:335–342

    PubMed  PubMed Central  Article  Google Scholar 

  10. 10.

    McGuire JF, Hanks CE, Lewin AB, Storch EA, Murphy TK (2013) Social deficits in children with chronic tic disorders: phenomenology, clinical correlates and quality of life. Compr Psychiatry 54:1023–1031

    PubMed  Article  PubMed Central  Google Scholar 

  11. 11.

    Pringsheim T, Okun MS, Muller-Vahl K, Martino D, Jankovic J, Cavanna AE et al (2019) Practice guideline recommendations summary: treatment of tics in people with Tourette syndrome and chronic tic disorders. Neurology 92:896–906

    PubMed  PubMed Central  Article  Google Scholar 

  12. 12.

    Wolraich ML, Hagan JF, Allan C, Chan E, Davison D, Earls M et al (2019) Clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics 144:e20192528

    PubMed  PubMed Central  Article  Google Scholar 

  13. 13.

    Eddy CM, Rickards HE, Cavanna AE (2011) Treatment strategies for tics in Tourette syndrome. Ther Adv Neurol Disord 4:25–45

    PubMed  PubMed Central  Article  Google Scholar 

  14. 14.

    Roessner V, Plessen KJ, Rothenberger A, Ludolph AG, Rizzo R, Skov L et al (2011) European guidelines for Tourette syndrome and other tic disorders. Part II: pharmacological treatment. Eur Child Adolesc Psychiatry 20:173–196

    PubMed  PubMed Central  Article  Google Scholar 

  15. 15.

    Abwender DA, Como PG, Kurlan R, Parry K, Fett KA, Cui L et al (1996) School problems in Tourette’s syndrome. Arch Neurol 53:509–511

    PubMed  Article  PubMed Central  Google Scholar 

  16. 16.

    Hanks CE, McGuire JF, Lewin AB, Storch EA, Murphy TK (2016) Clinical correlates and mediators of self-concept in youth with chronic tic disorders. Child Psychiatry Hum Dev 47:64–74

    PubMed  PubMed Central  Article  Google Scholar 

  17. 17.

    Lebowitz ER, Motlah MG, Katsovich L, King RA, Lombroso PJ, Grantz H et al (2012) Tourette syndrome in youth with and without obsessive compulsive disorder and attention deficit hyperactivity disorder. Eur Child Adolesc Psychiatry 21:451–457

    PubMed  PubMed Central  Article  Google Scholar 

  18. 18.

    Sukhodolsky DG, Scahill L, Zhang H, Peterson BS, King RA, Lombroso PJ et al (2003) Disruptive behavior in children with Tourette’s syndrome: association with ADHD comorbidity, tic severity, and functional impairment. J Am Acad Child Adolesc Psychiatry 42:98–105

    PubMed  Article  Google Scholar 

  19. 19.

    Spencer T, Biederman J, Harding M, O’Donnell D, Wilens T, Faraone S et al (1998) Disentangling the overlap between Tourette’s disorder and ADHD. J Child Psychol Psychiatry 39:1037–1044

    PubMed  Article  PubMed Central  Google Scholar 

  20. 20.

    Lin Y, Lai M, Gau SS (2012) Youths with ADHD with and without tic disorders: comorbid psychopathology, executive function and social adjustment. Res Dev Disabil 33:951–963

    PubMed  Article  PubMed Central  Google Scholar 

  21. 21.

    Steinhausen H, Nøvik TS, Baldursson G, Curatolo P, Lorenzo MJ, Rodrigues Pereira R et al (2006) Co-existing psychiatric problems in ADHD in the ADORE cohort. Eur Child Adolesc Psychiatry 15:j25-i29

    Article  Google Scholar 

  22. 22.

    Bramlett MD, Blumberg SJ, Zablotsky B, George JM, Ormson AE, Frasier AM et al (2017) Design and operation of the National Survey of Children’s Health, 2011–2012. Vital Health Stat 59:1–256

    Google Scholar 

  23. 23.

    Centers for Disease Control and Prevention (2015) 2014 National Survey of the Diagnosis and Treatment of ADHD and Tourette syndrome: frequently asked questions. http://www.cdc.gov/nchs/slaits/ns_data.htm. Accessed March 16, 2019.

  24. 24.

    Wolraich ML, Lambert W, Doffing MA, Bickman L, Simmons T, Worley K (2003) Psychometric properties of the Vanderbilt ADHD diagnostic parent rating scale in a referred population. J Pediatr Psychol 28:559–567

    PubMed  Article  PubMed Central  Google Scholar 

  25. 25.

    Eapen V, Črnčec R, McPherson S, Snedden C (2013) Tic disorders and learning disability: clinical characteristics, cognitive performance and comorbidity. Austral J Special Educ 37:162–172

    Article  Google Scholar 

  26. 26.

    Pham AV, Riviere A (2015) Specific learning disorders and ADHD: current issues in diagnosis across clinical and educational settings. Child Adolesc Disorders 17:38

    Google Scholar 

  27. 27.

    Zablotsky B, Bramlett MD, George JM, Bechara J, Santos KB, Ormson E et al (2019) Design and operation: 2013 National Survey of Children in Nonparental Care and 2014 National Survey of the Diagnosis and Treatment of ADHD and Tourette Syndrome: Programs and Collection Procedures. National Center for Health Statistics. Vital Health Stat 1:63

    Google Scholar 

  28. 28.

    Robertson MM (2008) The prevalence and epidemiology of Gilles de la Tourette syndrome: part 1: the epidemiological and prevalence studies. J Psychosom Res 65:461–472

    PubMed  Article  PubMed Central  Google Scholar 

  29. 29.

    Ramanujam K, Himle MB, Hayes LP, Woods DW, Scahill L, Sukhodolsky DG et al (2015) Clinical correlates and predictors of caregiver strain in children with chronic tic disorders. Child Health Care 44:249–263

    PubMed  Article  PubMed Central  Google Scholar 

  30. 30.

    Shin M, Chung S, Kang-E MH (2001) Comparative study of the behavioral and neuropsychologic characteristics of tic disorder with or without attention-deficit hyperactivity disorder. J Child Neurol 16:719–726

    PubMed  Article  PubMed Central  Google Scholar 

  31. 31.

    Wadman R, Glazebrook C, Beer C, Jackson GM (2016) Difficulties experienced by young people with Tourette syndrome in secondary school: a mixed methods description of self, parent and staff perspectives. BMC Psychiatry 16:1–11

    Article  Google Scholar 

  32. 32.

    Murphy TK, Lewin AB, Storch EA, Stock S, American Academy of Child and Adolescent Psychiatry Committee on Quality Issues (CQI) (2014) Practice parameter for the assessment and treatment of children and adolescents with tic disorders. J Am Acad Child Adolesc Psychiatry 52:1341–1359

    Article  Google Scholar 

  33. 33.

    Robertson MM (2008) The prevalence and epidemiology of Gilles de la Tourette syndrome: part 2: tentative explanations for differing prevalence figures in GTS, including the possible effects of psychopathology, aetiology, cultural differences, and differing phenotypes. J Psychosom Res 65:473–486

    PubMed  Article  PubMed Central  Google Scholar 

  34. 34.

    Agans JP, Champine RB, Johnson SK, Erickson K, Yalin C (2015) Promoting healthy lifestyles through youth activity participation: lessons from research. In: Bowers E et al (eds) Promoting positive youth development. Advancing responsible adolescent development. Springer, Cham

    Google Scholar 

  35. 35.

    La Greca AM, Bearman KJ, Moore H (2002) Peer relations of youth with pediatric conditions and health risks: promoting social support and healthy lifestyles. J Dev Behav Pediatr 23:271–280

    PubMed  Article  PubMed Central  Google Scholar 

  36. 36.

    Conelea CA, Woods DW, Zinner SH, Budman C, Murphy T, Scahill LD et al (2011) Exploring the impact of chronic tic disorders in youth: results from the Tourette Syndrome Impact Survey. Child Psychiatry Human Dev 42:219–242

    Article  Google Scholar 

  37. 37.

    Nasol E, Lindly OJ, Chavez AE, Zuckerman KE (2019) Unmet financial impact disparities for US children with ADHD. Acad Pediatr 19:315–324

    PubMed  Article  PubMed Central  Google Scholar 

  38. 38.

    Stewart SB, Greene DJ, Lessov-Schlaggar CN, Church JA, Schlaggar BL (2015) Clinical correlates of parenting stress in children with Tourette Syndrome and in typically developing children. J Pediatr 166:1297–1302

    PubMed  PubMed Central  Article  Google Scholar 

  39. 39.

    Bitsko RH, Danielson M, King M, Visser SN, Scahill L, Perou R (2012) Health care needs of children with Tourette syndrome. J Child Neurol 28:1626–1636

    PubMed  PubMed Central  Article  Google Scholar 

  40. 40.

    Knapp CA, Hinojosa M, Baron-Lee J, Fernandez-Baca D, Hinojosa R, Thompson L (2012) Factors associated with a medical home among children with Attention-Deficit Hyperactivity Disorder. Matern Child Health J 16:1771–1778

    PubMed  Article  PubMed Central  Google Scholar 

  41. 41.

    McGuire JF, Kugler BB, Park JM (2012) Evidence-based assessment of compulsive skin picking, chronic tic disorders and trichotillomania in children. Child Psychiatry Human Dev 43:855–883

    Article  Google Scholar 

  42. 42.

    Pelham WE, Fabiano GA, Massetti GM (2005) Evidence-based assessment of attention deficit hyperactivity disorder in children and adolescents. J Clin Child Adolesc Psychol 34:449–476

    PubMed  Article  PubMed Central  Google Scholar 

  43. 43.

    Barfell KSF, Snyder RR, Isaacs-Cloes KM, Garris JF, Roeckner AR, Horn PS et al (2017) Parent and patient perceptions of functional impairment due to Tourette syndrome: Development of a shortened version of the Child Tourette Syndrome Impairment Scale. J Child Neurol 32:725–730

    PubMed  Article  PubMed Central  Google Scholar 

  44. 44.

    Cloes KI, Barfell KS, Horn PS, Wu SW, Jacobson SE, Hart KJ et al (2017) Preliminary evaluation of child self-rating using the Child Tourette Syndrome Impairment Scale. Dev Med Child Neurol 59:284–290

    PubMed  Article  PubMed Central  Google Scholar 

  45. 45.

    Storch EA, Lack CW, Simons LE, Goodman WK, Murphy TK, Geffken GR (2007) A measure of functional impairment in youth with Tourette’s syndrome. J Pediatr Psychol 32:950–959

    PubMed  Article  PubMed Central  Google Scholar 

  46. 46.

    McGuire JF, Arnold E, Park JM, Nadeau JM, Lewin AB, Murphy TK et al (2015) Living with tics: reduced impairment and improved quality of life for youth with chronic tic disorders. Psychiatry Res 225:571–579

    PubMed  Article  PubMed Central  Google Scholar 

  47. 47.

    McGuire JF, Murphy TK, Piacentini J, Storch EA (2018) The clinician’s guide to treatment and management of youth with Tourette syndrome and TIC disorders. Elsevier Inc, London

    Google Scholar 

  48. 48.

    Antshel KM (2015) Psychosocial interventions in attention-deficit/hyperactivity disorder: update. Child Adolesc Psychiatr Clin 24:79–97

    Article  Google Scholar 

Download references

Funding

The authors disclosed receipt of the following financial support for research, authorship, and/or publication of this article: The research reported in this publication was funded by the Centers for Disease Control and Prevention (CDC); the National Center on Birth Defects and Developmental Disabilities (NCBDDD); and conducted by the National Center for Health Statistics (NCHS). Individuals were supported in part by National Institute of Mental Health (NIMH) K23MH113884 Grant funding to Dr. Ricketts, UL1TR000124 Grant funding to Dr. Rozenman, and an appointment to the Research Participation Program at the Centers for Disease Control and Prevention administered by the Oak Ridge Institute for Science and Education through an interagency agreement between the U.S. Department of Energy and CDC to Ms. Wolicki. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention or the National Institute of Mental Health.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Emily J. Ricketts.

Ethics declarations

Conflict of interest

Emily J. Ricketts, PhD has received research support from the National Institute of Mental Health (NIMH), the Tourette Association of America (TAA), and the BFRB Precision Medicine Initiative granted by the TLC Foundation for Body-Focused Repetitive Behaviors. She has received honoraria from the TAA, and serves on their Diversity Committee. Sara Beth Wolicki, MPH, CPH and Melissa L. Danielson declare that they have no conflict of interest. Michelle Rozenman, PhD has received research support from the NIMH, University of California, Los Angeles Clinical (UCLA) Translational Science Institute, the UCLA Friends of Semel Research Scholar Program, and the International OCD Foundation. Joseph F. McGuire, PhD has received research support from the NIMH, the TAA, American Academy of Neurology, and the American Brain Foundation. He is a consultant for Bracket, Syneos Health, and Luminopia, and also receives royalties from Elsevier. John Piacentini, PhD has received grant or research support from the NIMH, Pfizer Pharmaceuticals through the Duke University Clinical Research Institute CAPTN Network, Psyadon Pharmaceuticals, the TAA, and the BFRB Precision Medicine Initiative granted by the TLC Foundation for Body-Focused Repetitive Behaviors. He has received financial support from the Petit Family Foundation and the TAA Center of Excellence Gift Fund. He has received royalties from Guilford Press and Oxford University Press. He has served on the speakers’ bureau of the TAA, the International OCD Foundation, and the TLC Foundation for Body-Focused Repetitive Behaviors. Douglas W. Woods, PhD receives royalties from Oxford University Press, Guilford Press, and Springer Press, and receives speaking fees from the TAA. John T. Walkup, PhD receives royalties from Guildford Press and Oxford University Press for books on Tourette Syndrome. He also has received grant support, travel support and honoraria from the TAA. Jonathan W. Mink, MD, PhD is a consultant for Biomarin, Inc; Censa, Inc; Abide Therapeutics, Inc, Abide Therapeutics, Inc., TEVA Inc.; Has research contracts with Abeona, Inc.; receives honoraria from the American Academy of Neurology (Associate Editor of Neurology); receives royalties from Elsevier, Inc.; receives grant funding from NIH, Batten Disease Support and Research Association, Batten Research Alliance, AUCD. Rebecca H. Bitsko, PhD declares no conflicts of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animal participants performed by any authors. Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Ricketts, E.J., Wolicki, S.B., Danielson, M.L. et al. Academic, Interpersonal, Recreational, and Family Impairment in Children with Tourette Syndrome and Attention-Deficit/Hyperactivity Disorder. Child Psychiatry Hum Dev (2021). https://doi.org/10.1007/s10578-020-01111-4

Download citation

Keywords

  • Tourette syndrome
  • ADHD
  • Children
  • Academic performance
  • Social behavior
  • Interpersonal relations
  • Cost of illness