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. 2012 Feb;51(2):192-201.e5.
doi: 10.1016/j.jaac.2011.11.004. Epub 2011 Dec 23.

Prevalence of Tourette syndrome and chronic tics in the population-based Avon longitudinal study of parents and children cohort

Jeremiah M Scharf  1 , Laura L Miller, Carol A Mathews, Yoav Ben-Shlomo
Affiliations

Prevalence of Tourette syndrome and chronic tics in the population-based Avon longitudinal study of parents and children cohort

Jeremiah M Scharf et al. J Am Acad Child Adolesc Psychiatry. 2012 Feb.

Abstract

Objective: Recent epidemiologic studies have demonstrated that Tourette syndrome (TS) and chronic tic disorder (CT) are more common than previously recognized. However, few population-based studies have examined the prevalence of co-occurring neuropsychiatric conditions such as obsessive-compulsive disorder (OCD) and attention-deficit/hyperactivity disorder (ADHD). We evaluated the prevalence of TS, CT, and their overlap with OCD and ADHD in the Avon Longitudinal Study of Parents and Children (ALSPAC) birth cohort.

Method: A total of 6,768 children were evaluated using longitudinal data from mother-completed questionnaires. DSM-IV-TR diagnoses of TS and CT were derived using three levels of diagnostic stringency (Narrow, Intermediate, and Broad). Validity of the case definitions was assessed by comparing gender ratios and rates of co-occurring OCD and ADHD using heterogeneity analyses.

Results: Age 13 prevalence rates for TS (0.3% for Narrow; 0.7% for Intermediate) and CT (0.5% for Narrow; 1.1% for Intermediate) were consistent with rates from other population-based studies. Rates of co-occurring OCD and ADHD were higher in TS and CT Narrow and Intermediate groups compared with controls but lower than has been previously reported. Only 8.2% of TS Intermediate cases had both OCD and ADHD; 69% of TS Intermediate cases did not have either co-occurring OCD or ADHD.

Conclusions: This study suggests that co-occurring OCD and ADHD is markedly lower in TS cases derived from population-based samples than has been reported in clinically ascertained TS cases. Further examination of the range of co-occurring neuropsychiatric disorders in population-based TS samples may shed new perspective on the underlying shared pathophysiology of these three neurodevelopmental conditions.

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Figures

FIGURE S1
FIGURE S1
Overlap of Tourette syndrome (TS)/chronic tics (CT), obsessive-compulsive disorder (OCD) and attention-deficit/hyperactivity disorder (ADHD) diagnoses in the Avon Longitudinal Study of Parents and Children (ALSPAC) using the TS and CT narrow case definitions. (a) TS Narrow (TSn). Comparison of overlap between TS, OCD, and ADHD cases using the TSn case definition. Note: Percentages indicate the fraction of subjects in each subgroup. Percentages on either side of the dotted line indicate the different fractional percent of individuals with overlapping (co-occurring) conditions relative to the disorder of reference. For example, the two cases of TS+OCD+ADHD at the center of the diagram represent 8.7% of the total TS sample, but only 1.1% of the OCD and 1.3% of the ADHD samples, respectively. (b) TS or CT Narrow (TSCTn). Comparison of overlapping conditions between any chronic tic disorder (TS or CT), OCD, and ADHD.
FIGURE 1
FIGURE 1
Study flow diagram. CT = chronic tics; SEN = Special Educational Needs statement; TS = Tourette syndrome.
FIGURE 2
FIGURE 2
Overlap of Tourette syndrome (TS)/chronic tics (CT), obsessive-compulsive disorder (OCD) and attention-deficit/hyperactivity disorder (ADHD) diagnoses in the Avon Longitudinal Study of Parents and Children. (a) Comparison of overlap among TS, OCD, and ADHD cases using the TS Intermediate (TSi) definition. Note: Percentages indicate the fraction of subjects in each subgroup. Percentages on either side of the dotted line indicate the different fractional percent of individuals with overlapping conditions relative to the disorder of reference. For example, the five cases of TS+ADHD without OCD represent 10.2% of the total TS sample but only 3.1% of the ADHD sample. Similarly, the four TS+OCD+ADHD cases at the center of the diagram represent 8.2% of the TS sample but only 2.2% of the OCD and 2.5% of the ADHD samples, respectively. (b) Comparison of overlapping conditions between any chronic tic disorder (TS or CT), OCD and ADHD using the Intermediate case definitions of TS or CT (TSCTi).
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